BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SURGICLIP

    MDR report key: 1871313 · Received September 27, 2010

    Report

    Report Number
    1871313
    Event Type
    Malfunction
    Date Received
    September 27, 2010
    Date of Event
    July 28, 2010
    Report Date
    September 27, 2010
    Manufacturer
    COVIDIEN
    Product Code
    GDO
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    MI, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    SURGICLIP WOULD NOT FIRE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SURGICLIP APPLIER, SURGICAL CLIP GDO COVIDIEN * P0D0187

    Patients

    Seq Age Sex Outcome Treatment
    1 75 YR