BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    COVIDIEN

    MDR report key: 1612111 · Received February 17, 2010

    Report

    Report Number
    MW5014825
    Event Type
    Malfunction
    Date Received
    February 17, 2010
    Date of Event
    July 28, 2009
    Report Date
    February 17, 2010
    Product Code
    GDW
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    WHITE RELOAD FIRED AND TISSUE. INSTRUMENT WOULD NOT RELEASE CARTRIDGE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 COVIDIEN WHITE ROTIC LOAD GDW 030454

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR