BEUDAMED
    FDA Adverse Event Other Summary report: N

    *

    MDR report key: 490848 · Received October 23, 2003

    Report

    Report Number
    490848
    Event Type
    Other
    Date Received
    October 23, 2003
    Date of Event
    February 1, 2003
    Report Date
    April 1, 2003
    Manufacturer
    UNK
    Product Code
    KBZ
    Report Source
    User Facility report
    Reporter Location
    DC, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    A GLASS TONSIL SYRINGE BROKE WHILE INJECTING BUT APPEARED INTACT. A GLASS PIECE WAS RETRIEVED FROM THE SURGICAL DRAPE BUT NONE WAS FOUND ON THE PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 * TONSIL SYRINGE KBZ UNK * *

    Patients

    Seq Age Sex Outcome Treatment
    1 3 YR Other