BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LIGASURE IMPACT

    MDR report key: 2041550 · Received March 10, 2011

    Report

    Report Number
    1717344-2011-00176
    Event Type
    Malfunction
    Date Received
    March 10, 2011
    Date of Event
    January 4, 2011
    Report Date
    February 10, 2011
    Manufacturer
    COVIDIEN LP (VALLEYLAB)
    Product Code
    GEI
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TN, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). THE INCIDENT DEVICE HAS BEEN REC'D AND IS UNDER EVAL. WHEN THE DEVICE EVAL IS COMPLETE A F/U REPORT WILL BE SUBMITTED.

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED THAT THE DEVICE STOPPED WORKING DURING A HYSTERECTOMY. THERE WAS NO PT INJURY. THE DEVICE WAS RETURNED WITH THE BLADE PROTRUDING FROM THE JAWS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LIGASURE IMPACT LIGASURE VESSEL SEALING SYSTEM GEI COVIDIEN LP (VALLEYLAB) 196672L

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK