BEUDAMED
    FDA Adverse Event Summary report: N

    LIGACLIP MCA SMALL APPLIER

    MDR report key: 1003856 · Received February 5, 2008

    Report

    Report Number
    1527736-2008-00684
    Date Received
    February 5, 2008
    Date of Event
    September 26, 2007
    Report Date
    January 14, 2008
    Manufacturer
    ETHICON ENDO-SURGERY, INC.
    Product Code
    GDO
    PMA / PMN Number
    K820837
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    KS, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    DATE SENT: 2/15/2008. INFO ANTICIPATED, BUT UNAVAILABLE AT THIS TIME.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE DEVICE JAMMED AND WOULD NOT RELEASE A CLIP. THEY USED ANOTHER LIKE DEVICE TO COMPLETE THE CASE WITH NO PT CONSEQUENCE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LIGACLIP MCA SMALL APPLIER GDO ETHICON ENDO-SURGERY, INC. NA D4GK6T

    Patients

    Seq Age Sex Outcome Treatment
    1