BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ADULT LARYNGOSCOPE BLADE EXTENDER KIT

    MDR report key: 526770 · Received February 20, 2004

    Report

    Report Number
    1519132-2004-00006
    Event Type
    Malfunction
    Date Received
    February 20, 2004
    Date of Event
    January 20, 2004
    Report Date
    February 19, 2004
    Manufacturer
    ACMI NORWALK
    Product Code
    EQN
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    THE BLADE EXTENDER, ITEM LAR-AE, BECAME DETACHED FROM THE LARYNGOSCOPE AND WAS LOST DURING USE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ADULT LARYNGOSCOPE BLADE EXTENDER KIT LARYNGOSCOPE EQN ACMI NORWALK LAR-AE UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN