FDA Adverse Event Other Summary report: N

HEMOLOK LIGATING CLIP

MDR report key: 1060931 · Received June 12, 2008

Report

Report Number
3003898360-2008-00036
Event Type
Other
Date Received
June 12, 2008
Report Date
May 27, 2008
Manufacturer
TELEFLEX MEDICAL
Product Code
GDO
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
IL, US
Reporter Occupation
PHYSICIAN

Narratives

Additional Manufacturer Narrative · 1

UNABLE TO DETERMINE AT THIS TIME DUE TO LACK OF CATALOG #. AT TIME OF THIS REPORT, THERE IS NO INFO TO IDENTIFY CATALOG # OR LOT #. ADDITIONAL INFO HAS BEEN REQUESTED. A FOLLOW UP REPORT WILL BE SENT IF ANY ADDITIONAL INFO IS RECEIVED.

Description of Event or Problem · 1

INCIDENT REPORTED AS: THE SALES REP RECEIVED A CALL FROM A DR WHO SAID PT HAD HEMOCLIPS PLACED IN HER DURING A GYN SURGICAL PROCEDURE IN 1999. THE PT DEVELOPED A NEUROLOGICAL DISEASE CALLED STIFF MAN'S SYNDROME USUALLY CAUSED BY EXPOSURE TO COBALT OR NICKLE. SHE IS ASKING THE DR TO REMOVE CLIPS. THEY DO NOT KNOW CATALOG # OR LOT # INVOLVED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 HEMOLOK LIGATING CLIP LIGATING CLIPS GDO TELEFLEX MEDICAL UNK

Patients

Seq Age Sex Outcome Treatment
1