BEUDAMED
    FDA Adverse Event Other Summary report: N

    MINI REVO TAP

    MDR report key: 512716 · Received February 13, 2004

    Report

    Report Number
    1017294-2004-00002
    Event Type
    Other
    Date Received
    February 13, 2004
    Date of Event
    December 23, 2003
    Report Date
    December 23, 2003
    Manufacturer
    LINVATEC CORP.
    Product Code
    HWX
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    MINI REVO TAP BROKE OFF INSIDE PATIENT'S SHOULDER DURING SURGERY. SURGEON UNABLE TO RETRIEVE IT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MINI REVO TAP MINI REVO TAP HWX LINVATEC CORP. NA NA

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other