BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ETHICON

    MDR report key: 1843398 · Received September 22, 2010

    Report

    Report Number
    MW5017528
    Event Type
    Injury
    Date Received
    September 22, 2010
    Date of Event
    September 16, 2010
    Report Date
    September 16, 2010
    Manufacturer
    ETHICON
    Product Code
    GDW
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    TX, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    ECHELON 60 RELOAD (B)(4) LOT#64TK4U EXP 6/2015, MISFIRED DURING LAPAROSCOPIC GASTRIC BYPASS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ETHICON ECHELON 60 VASCULAR RELOAD GDW ETHICON ECR60W 64TK4U

    Patients

    Seq Age Sex Outcome Treatment
    1 36 YR Hospitalization