BEUDAMED
    FDA Adverse Event Other Summary report: N

    HUMI

    MDR report key: 505921 · Received January 8, 2004

    Report

    Report Number
    1216677-2003-00019
    Event Type
    Other
    Date Received
    January 8, 2004
    Date of Event
    November 6, 2003
    Report Date
    January 7, 2004
    Manufacturer
    COOPERSURGICAL, INC.
    Product Code
    LKF
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    DURING A PROCEDURE, DEVICE BROKE INSIDE THE PT. BROKEN PIECE WAS REMOVED BY FORCEPS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HUMI UTERINE MANIPULATOR/INJETOR LKF COOPERSURGICAL, INC. 6001 UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 * Required Intervention