BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    JARIT 350-370

    MDR report key: 5996424 · Received September 30, 2016

    Report

    Report Number
    MW5065158
    Event Type
    Malfunction
    Date Received
    September 30, 2016
    Date of Event
    September 29, 2016
    Report Date
    September 30, 2016
    Manufacturer
    JARIT
    Product Code
    KCH
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    KY, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    WHEN USING A 2 PRONG SKIN HOOK A PIECE CAME OFF THE METAL SKIN HOOK WHICH WAS THEN SECURED AND NOT LEFT IN THE PATIENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    643833 JARIT 350-370 SKIN HOOK KCH JARIT 100088-1401

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR