BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    RETRACTOR, 80MM ANG TRIANGULAR

    MDR report key: 511002 · Received January 14, 2004

    Report

    Report Number
    1038548-2004-00003
    Event Type
    Malfunction
    Date Received
    January 14, 2004
    Date of Event
    July 25, 2003
    Report Date
    January 14, 2004
    Manufacturer
    SNOWDEN PENCER, INC.
    Product Code
    GAD
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    VA, US
    Reporter Occupation
    INVALID DATA

    Narratives

    Description of Event or Problem · 1

    THE CABLE BROKE WITHIN THE INSTRUMENT AND BITS OF SEGMENTS FELL OFF INTO THE PT'S ABDOMEN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RETRACTOR, 80MM ANG TRIANGULAR * GAD SNOWDEN PENCER, INC. 89-6112 *

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN