BEUDAMED
    FDA Adverse Event Injury Summary report: N

    D+K USA RGA #5110

    MDR report key: 559509 · Received October 26, 2004

    Report

    Report Number
    MW1033687
    Event Type
    Injury
    Date Received
    October 26, 2004
    Date of Event
    June 1, 2004
    Report Date
    October 26, 2004
    Manufacturer
    DUCKWORTH & KENT USA LTD.
    Product Code
    MDM
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NY, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    TIP OF INSTRUMENT BROKE OFF AND FELL IN PT'S EYE AND WAS RETRIEVED. NO INJURY TO PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 D+K USA RGA #5110 EYE INSTRUMENT MDM DUCKWORTH & KENT USA LTD. H2005-1 *

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Other| R