BEUDAMED
    FDA Adverse Event Injury Summary report: N

    3.0MM SABER SUCTION WAND

    MDR report key: 622040 · Received July 6, 2005

    Report

    Report Number
    1056128-2005-00001
    Event Type
    Injury
    Date Received
    July 6, 2005
    Date of Event
    April 25, 2005
    Report Date
    May 5, 2005
    Manufacturer
    VANGUARD MEDICAL CONCEPTS, INC.
    Product Code
    JOL
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WY, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    TIP DETACHED FROM ARTHROSCOPIC SUCTION WAND DURING ARTHROSCOPIC SURGERY. AN X-RAY WAS USED TO LOCATE TIP FOR REMOVAL. TIP WAS REMOVED BY SURGEON WITHOUT FURTHER INCIDENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 3.0MM SABER SUCTION WAND ORTHOPEDIC JOL VANGUARD MEDICAL CONCEPTS, INC. * 550536

    Patients

    Seq Age Sex Outcome Treatment
    1 31 YR Required Intervention