BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MERCURY MEDICAL

    MDR report key: 676260 · Received October 6, 2004

    Report

    Report Number
    1024404-2004-00031
    Event Type
    Malfunction
    Date Received
    October 6, 2004
    Report Date
    June 30, 2004
    Manufacturer
    MERCURY MEDICAL
    Product Code
    CCW
    Removal / Correction Number
    NA
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    LIGHT BUNDLE CAME OFF FROM THE BLADE. NO PATIENT, INJURY OR DEATH INVOLVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MERCURY MEDICAL 2001 FIBEROPTIC LARYNGOSCOPE CCW MERCURY MEDICAL CLM #3 E10

    Patients

    Seq Age Sex Outcome Treatment
    1 NO INFO