MAUDE MDR 3851607

MDR report key
3851607
Report number
1044475-2014-00070
Event key
0
Event type
3
Date of event
2014-02-26
Date received
2014-03-25
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
MARGIE BURTON, RN, REG AFFAIRS
Address
P.O. BOX 12600 RTP NC 27709 US
Phone
919-919-9194
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1RUSCH EMERALD FO MILLER BLADE 4LARYNGOSCOPE BLADE (FIBEROPTIC)TELEFLEXCAL0044544001135Y Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12014-03-250

Event Narratives#

D

Patient 1

THE COMPLAINT IS REPORTED AS: THE CUSTOMER ALLEGES THAT THE LIGHT ON THE BLADE IS NOT WORKING. THE ISSUE WAS DETECTED PRIOR TO USE.

N

Patient 1

THE DEVICE SAMPLE WAS RECEIVED BY THE MFR, BUT THE INVESTIGATION IS INCOMPLETE AT THE TIME OF THIS REPORT.