BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    AESCULAP PRESTIGE

    MDR report key: 1870625 · Received October 2, 2010

    Report

    Report Number
    MW5017714
    Event Type
    Malfunction
    Date Received
    October 2, 2010
    Date of Event
    September 22, 2010
    Report Date
    October 1, 2010
    Manufacturer
    B BRAUN
    Product Code
    GCJ
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    DURING PROCEDURE LAPAROSCOPIC GRASPER JAW BROKE OFF INSIDE THE ABDOMEN OF THE PT. PIECE WAS RETRIEVED, NO HARM TO PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 AESCULAP PRESTIGE LAPAROSCOPIC 5MM ACTION GRASPER (FRENCH FRY GRASPER) GCJ B BRAUN

    Patients

    Seq Age Sex Outcome Treatment
    1 81 YR