BEUDAMED
    FDA Adverse Event Other Summary report: N

    CARROL-GIRARD SCREW

    MDR report key: 497912 · Received November 20, 2003

    Report

    Report Number
    1032347-2003-00015
    Event Type
    Other
    Date Received
    November 20, 2003
    Date of Event
    October 21, 2003
    Report Date
    October 21, 2003
    Manufacturer
    W. LORENZ SURGICAL, INC.
    Product Code
    GEG
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GA, US
    Reporter Occupation
    INVALID DATA

    Narratives

    Description of Event or Problem · 1

    ZYGOMATIC ARCH WAS FRACTURED, INSERTED SCREW, WHILE PULLING IT OUT, IT BROKE. UNABLE TO REMOVE SMALL FRAGMENT OF INSTRUMENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CARROL-GIRARD SCREW GENERAL INSTRUMENTATION GEG W. LORENZ SURGICAL, INC. * 318080

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other