BEUDAMED
    FDA Adverse Event Other Summary report: N

    FREER ELEVATOR BY V. MUELLER

    MDR report key: 464544 · Received June 3, 2003

    Report

    Report Number
    MW1028623
    Event Type
    Other
    Date Received
    June 3, 2003
    Date of Event
    May 7, 2003
    Report Date
    June 3, 2003
    Manufacturer
    CARDINAL/V. MUELLER HEALTH CARE
    Product Code
    GEG
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    WHILE MD MANIPULATING INTERNAL NOSE WITH "FREER" ELEVATOR, INSTRUMENT BROKE OFF IN NOSE - PARTIALLY. PORTION OF INSTRUMENT RETRIEVED IN PT'S THROAT. NO KNOWN INJURY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 FREER ELEVATOR BY V. MUELLER NASAL FRACTURE BONE ELEVATOR GEG CARDINAL/V. MUELLER HEALTH CARE RH 750 *

    Patients

    Seq Age Sex Outcome Treatment
    1 34 YR Other