BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CODMAN HOEN ANGULAR FORCEPS

    MDR report key: 4302589 · Received November 25, 2014

    Report

    Report Number
    4302589
    Event Type
    Malfunction
    Date Received
    November 25, 2014
    Date of Event
    November 24, 2014
    Report Date
    November 25, 2014
    Manufacturer
    SYMMETRY SURGICAL, A DIVISION OF SYMMETRY MEDICAL
    Product Code
    GDJ
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    NC, US

    Narratives

    Description of Event or Problem · 1

    DURING REVISION OF FEMORAL STEM WITH CONVERSION TO A HIP REPLACEMENT ON AN ELDERLY FEMALE, ALLIGATOR CLAMP BROKE. BROKEN PIECE OF INSTRUMENT RETRIEVED BY SURGEON WITH NO HARM TO PATIENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    766415 CODMAN HOEN ANGULAR FORCEPS FORCEPS, GENERAL & PLASTIC SURGERY GDJ SYMMETRY SURGICAL, A DIVISION OF SYMMETRY MEDICAL 30-1230 *

    Patients

    Seq Age Sex Outcome Treatment
    1 76 YR NOT KNOWN.