BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PREMIUM SURGICLIP

    MDR report key: 17572107 · Received August 18, 2023

    Report

    Report Number
    17572107
    Event Type
    Malfunction
    Date Received
    August 18, 2023
    Date of Event
    July 17, 2023
    Report Date
    August 4, 2023
    Manufacturer
    COVIDIEN LP
    Product Code
    FZP
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    OH
    Reporter Occupation
    RISK MANAGER
    Health Professional
    N

    Narratives

    Description of Event or Problem · 0

    COVIDIEN LP PREMIUM SURGICLIP CLIP APPLIER MISFIRED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    2127160 PREMIUM SURGICLIP CLIP, IMPLANTABLE FZP COVIDIEN LP 134048 P3A0211

    Patients

    Seq Age Sex Outcome Treatment
    1 29200 DA Male