BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    COVIDIEN

    MDR report key: 1613733 · Received February 18, 2010

    Report

    Report Number
    MW5014865
    Event Type
    Malfunction
    Date Received
    February 18, 2010
    Date of Event
    July 24, 2009
    Report Date
    February 18, 2010
    Manufacturer
    COVIDIEN
    Product Code
    GDO
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    CLIP APPLIER MALFUNCTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 COVIDIEN ENDOCLIP 2 GDO COVIDIEN ENDO CLIP 2 5MM N9F0231

    Patients

    Seq Age Sex Outcome Treatment
    1 47 YR