KARL STORZ W15AP 7674 MBI *

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 1999-07-13 for KARL STORZ W15AP 7674 MBI * manufactured by Karl Storz.

Event Text Entries

[142395] Tip of corkscrew broke off during surgery.
Patient Sequence No: 1, Text Type: D, B5

MAUDE Entry Details

• Report Number: 231791
• MDR Report Key: 231791
• Date Received: 1999-07-13
• Date of Report: 1999-07-09
• Date of Event: 1999-06-01
• Date Facility Aware: 1999-06-08
• Report Date: 1999-07-09
• Date Added to Maude: 1999-07-16
• Event Key: 0
• Report Source Code: User Facility report
• Manufacturer Link: N
• Number of Patients in Event: 0
• Adverse Event Flag: 3
• Product Problem Flag: 3
• Reprocessed and Reused Flag: 0
• Health Professional: 3
• Initial Report to FDA: 3
• Report to FDA: 3
• Event Location: 3
• Single Use: 0
• Previous Use Code: 0
• Event Type: 3
• Type of Report: 3

Device Details

• Brand Name: KARL STORZ
• Generic Name: CORKSCREW
• Product Code: HWI
• Date Received: 1999-07-13
• Model Number: W15AP 7674 MBI
• Catalog Number: *
• Lot Number: *
• ID Number: *
• Operator: HEALTH PROFESSIONAL
• Device Availability: N
• Device Age: *
• Implant Flag: N
• Date Removed: *
• Device Sequence No: 1
• Device Event Key: 224683
• Manufacturer: KARL STORZ
• Manufacturer Address: 600 CORPORATE POINT CULVER CITY CA 90230 US

Patients

Patient Number	Treatment	Outcome	Date
1	0	1. Required No Informationntervention	1999-07-13