MAUDE MDR 219075

MDR report key
219075
Report number
1038548-1999-00023
Event key
0
Event type
3
Date of event
1999-03-18
Date received
1999-04-15
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
2
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
MR PETER STEGAGNO, DIRECTOR, QA/RA
Address
5175 S. ROYAL ATLANTA DR TUCKET GA 30084 US
Phone
770-770-7707
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1DIAMOND-FLEX GRASPERSURGICAL INSTRUMENT, ENDOSCOPE AND ACCESSORIESGENZYME SURGICAL PRODUCTSGEN*89-0500*NYN

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
11999-04-150

Event Narratives#

D

Patient 1

COMPLAINANT ALLEGED ONE OF THE LINKAGES ON THE INSTRUMENT BROKE OFF. THEY RETRIEVED HALF OF IT, AND LEFT THE OTHER HALF IN THE PT.