BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    V. MUELLER TONSIL WIRE

    MDR report key: 436162 · Received January 6, 2002

    Report

    Report Number
    MW1027154
    Event Type
    Malfunction
    Date Received
    January 6, 2002
    Date of Event
    November 11, 2002
    Report Date
    December 17, 2002
    Manufacturer
    CARDINAL HEALTHCARE
    Product Code
    KBZ
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PHYSICIAN WENT TO SNARE TONSIL AND TONSIL WIRE BROKE OFF INTO SMALL PIECE. WIRE RETRIEVED. NO PT HARM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 V. MUELLER TONSIL WIRE TONSIL SNARE WIRE, 4", SIZSE 8 KBZ CARDINAL HEALTHCARE M02010-008 *

    Patients

    Seq Age Sex Outcome Treatment
    1 5 YR Other