BEUDAMED
    FDA Adverse Event Other Summary report: N

    IHS #C4-13968

    MDR report key: 558252 · Received July 29, 2004

    Report

    Report Number
    MW1032856
    Event Type
    Other
    Date Received
    July 29, 2004
    Date of Event
    July 28, 2004
    Manufacturer
    *
    Product Code
    FQP
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    WA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    BULB EXPLODED AFTER TOUCHING METAL INSIDE OF SHADE. PROVIDER WAS USING IT TO ILLUMINATE PT'S KNEE WHILE SUTURING. SHADE WAS NOTED TO BE LOOSE UPON INSPECTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 IHS #C4-13968 LAMP - HIGH INTENSITY FQP * * *

    Patients

    Seq Age Sex Outcome Treatment
    1 50 YR Other