BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MERCURY MEDICAL

    MDR report key: 677815 · Received October 6, 2004

    Report

    Report Number
    1024404-2004-00003
    Event Type
    Malfunction
    Date Received
    October 6, 2004
    Report Date
    June 30, 2004
    Manufacturer
    MERCURY MEDICAL
    Product Code
    CCW
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    BUNDLE FELL OFF DURING PT USE. NO INJURY OR DEATH REPORTED.

    Devices

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

    Patients

    Seq Age Sex Outcome Treatment
    1 NO INFO