BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    HARMONIC WAVE COAGULATING SHEARS WITH SCISSOR HANLDE AND HAND CONTROL

    MDR report key: 1160691 · Received September 5, 2008

    Report

    Report Number
    3005075853-2008-01537
    Event Type
    Malfunction
    Date Received
    September 5, 2008
    Report Date
    August 12, 2008
    Manufacturer
    ETHICON ENDO-SURGERY, LLC.
    Product Code
    LFL
    PMA / PMN Number
    K062000
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    DATE SENT: 09/05/2008. INFORMATION ANTICIPATED, BUT UNAVAILABLE AT THIS TIME.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT DURING AN ANTERIOR RECTUM RESECTION, THE TEFLON PAD WAS LOOSE, FELL INTO THE PATIENT AND WAS REMOVED. NO FURTHER INFORMATION IS AVAILABLE. ANOTHER DEVICE WAS USED TO COMPLETE THE CASE. THERE WAS NO ADVERSE CONSEQUENCE TO THE PATIENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HARMONIC WAVE COAGULATING SHEARS WITH SCISSOR HANLDE AND HAND CONTROL LFL ETHICON ENDO-SURGERY, LLC. NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 HANDPIECE| GENERATOR