BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ENDOSCOPIC MULTIPLE CLIP APPLIER

    MDR report key: 1925982 · Received December 9, 2010

    Report

    Report Number
    1925982
    Event Type
    Malfunction
    Date Received
    December 9, 2010
    Date of Event
    December 3, 2010
    Report Date
    December 9, 2010
    Manufacturer
    ETHICON ENDO-SURGERY
    Product Code
    FZP
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    AZ, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    MISFIRED THREE TIMES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ENDOSCOPIC MULTIPLE CLIP APPLIER LIGAMAX 5 FZP ETHICON ENDO-SURGERY EL5ML G4TX76

    Patients

    Seq Age Sex Outcome Treatment
    1 39 YR