BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TA

    MDR report key: 13009675 · Received December 15, 2021

    Report

    Report Number
    13009675
    Event Type
    Malfunction
    Date Received
    December 15, 2021
    Date of Event
    November 4, 2021
    Report Date
    December 2, 2021
    Manufacturer
    COVIDIEN LP
    Product Code
    GDW
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    UT
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL
    Health Professional
    Yes

    Narratives

    Description of Event or Problem · 0

    THE STAPLER LOAD, OF THE COVIDIEN LP TA¿ STAPLER, DID NOT SNAP INTO THE STAPLER PROPERLY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1906792 TA STAPLE, IMPLANTABLE GDW COVIDIEN LP TA6035S P1F1565

    Patients

    Seq Age Sex Outcome Treatment
    1 25550 DA Female