BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SPONGE HOLDING FORCEPS

    MDR report key: 7062774 · Received November 28, 2017

    Report

    Report Number
    7062774
    Event Type
    Malfunction
    Date Received
    November 28, 2017
    Date of Event
    November 6, 2017
    Report Date
    November 22, 2017
    Manufacturer
    CODMAN & SHURTLEFF, INC.
    Product Code
    HCZ
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    VA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    TIP OF FORCEPS BROKE OFF DURING USE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    844751 SPONGE HOLDING FORCEPS INSTRUMENT, SURGICAL, FORCEPS HCZ CODMAN & SHURTLEFF, INC. 32-6010

    Patients

    Seq Age Sex Outcome Treatment
    1 GAUZE SPONGE WAS BEING CLAMPED WITH INSTRUMENT.