BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ILM MICROFORCEP

    MDR report key: 838758 · Received April 11, 2007

    Report

    Report Number
    MW1042558
    Event Type
    Injury
    Date Received
    April 11, 2007
    Date of Event
    March 28, 2007
    Report Date
    March 28, 2007
    Manufacturer
    SYNERGETICS INC
    Product Code
    HNR
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    LA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    DURING RETINAL DETACHMENT REPAIR UNDER MICROSCOPE ILM TANO MICROFORCEP TIP BROKE OFF INTO PT'S EYE. MD MANIPULATED EYE TO RETRIEVE BROKEN PIECE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ILM MICROFORCEP TANO MICROFORCEP HNR SYNERGETICS INC 39.23 *

    Patients

    Seq Age Sex Outcome Treatment
    1 65 YR Required Intervention