BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BABCOCK FORCEPS, ROTO-LOK, LOCKING LEVER, 5MM, 3

    MDR report key: 924869 · Received October 4, 2007

    Report

    Report Number
    2430952-2007-00044
    Event Type
    Malfunction
    Date Received
    October 4, 2007
    Report Date
    October 4, 2007
    Manufacturer
    KOSCHER & WUERTZ GMBH
    Product Code
    GEN
    Product Problem
    Yes
    Report Source
    Distributor report
    Reporter Location
    MO, US
    Reporter Occupation
    INVALID DATA

    Narratives

    Description of Event or Problem · 1

    THE USER FACILITY REPORTED THAT THE DEVICE WAS INVOLVED IN A PERFORATED (RUPTURED) ILIUM. ADDITIONAL INFORMATION HAS BEEN REQUESTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BABCOCK FORCEPS, ROTO-LOK, LOCKING LEVER, 5MM, 3 ENDOSCOPIC INSTRUMENT GEN KOSCHER & WUERTZ GMBH * *

    Patients

    Seq Age Sex Outcome Treatment
    1 *