STORZ-NEZHART DORSEY IRRIGATION PUMP *

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 1995-01-31 for STORZ-NEZHART DORSEY IRRIGATION PUMP * manufactured by Karl Storz.

Event Text Entries

[48481] Fitting at case sheared off while attached to co2 tank and under pressure. Hose and fitting hit employee standing one foot away striking lower abdomen and leg causing ecchymoses.
Patient Sequence No: 1, Text Type: D, B5

MAUDE Entry Details

• Report Number: 83736
• MDR Report Key: 83736
• Date Received: 1995-01-31
• Date Added to Maude: 1997-04-16
• 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: STORZ-NEZHART DORSEY IRRIGATION PUMP
• Generic Name: *
• Product Code: FEQ
• Date Received: 1995-01-31
• Model Number: *
• Catalog Number: *
• Lot Number: *
• ID Number: *
• Device Availability: *
• Device Age: *
• Implant Flag: N
• Date Removed: *
• Device Sequence No: 1
• Device Event Key: 83040
• Manufacturer: KARL STORZ
• Manufacturer Address: * * *

Patients

Patient Number	Treatment	Outcome	Date
1	0		1995-01-31