BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    GRAY REVISION CEMENT FORCEPS

    MDR report key: 56581 · Received October 2, 1996

    Report

    Report Number
    2219689-1996-00092
    Event Type
    Malfunction
    Date Received
    October 2, 1996
    Date of Event
    August 28, 1996
    Report Date
    October 1, 1996
    Manufacturer
    HOWMEDICA INC.
    Product Code
    LZV
    Removal / Correction Number
    NA
    Report Source
    Manufacturer report
    Reporter Location
    WY, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    WHILE SURGEON WAS REMOVING CEMENT WITH THE CEMENT FORCEPS THE END SNAPPED OFF. THE BROKEN END WAS RETRIEVED AND REMOVED FROM THE CANAL. THERE WAS NO ADVERSE CONSEQUENCE TO THE PT DUE TO THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 GRAY REVISION CEMENT FORCEPS INSTRUMENT LZV HOWMEDICA INC. NA NA

    Patients

    Seq Age Sex Outcome Treatment
    1 86 YR Other