BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MW5079152

    MDR report key: 7784472 · Received August 14, 2018

    Report

    Report Number
    MW5079152
    Event Type
    Malfunction
    Date Received
    August 14, 2018
    Date of Event
    August 8, 2018
    Report Date
    August 13, 2018
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    KY, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    ENDO TECH AND PHYSICIAN ADVANCED RESOLUTION 360 CLIP OUT THE DISTAL END OF THE ENDOSCOPE. THE CLIP WAS NOT ON THE END OF THE DELIVERY DEVICE. ENDO TECH WASHING SCOPE IN THE SCOPE ROOM WAS ABLE TO BRUSH THE SCOPE AND THE CLIP CAME OUT.

    Patients

    Seq Age Sex Outcome Treatment
    1 79 YR