BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    STORZ LEIVERS MOUTH GAG FRAME, ADULT SIZE

    MDR report key: 53681 · Received November 27, 1996

    Report

    Report Number
    1932180-1996-00110
    Event Type
    Malfunction
    Date Received
    November 27, 1996
    Date of Event
    October 22, 1996
    Report Date
    October 29, 1996
    Manufacturer
    STORZ INSTRUMENT CO.
    Product Code
    KBN
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    WHILE PREPARING FOR A PROCEDURE, THIS MOUTH GAG BROKE AS IT WAS BEING LOADED JUST PRIOR TO USE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 STORZ LEIVERS MOUTH GAG FRAME, ADULT SIZE MOUTH GAG KBN STORZ INSTRUMENT CO. NA NA

    Patients

    Seq Age Sex Outcome Treatment
    1 NO INFO