BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ECHELON 45

    MDR report key: 2061698 · Received April 18, 2011

    Report

    Report Number
    3005075853-2011-01554
    Event Type
    Malfunction
    Date Received
    April 18, 2011
    Date of Event
    March 28, 2011
    Report Date
    March 29, 2011
    Manufacturer
    ETHICON ENDO-SURGERY, LLC.
    Product Code
    GDW
    PMA / PMN Number
    K051002
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). INFORMATION ANTICIPATED, BUT UNAVAILABLE AT THIS TIME.

    Additional Manufacturer Narrative · 1

    (B)(4). INFORMATION IS UNAVAILABLE; DEVICE WAS NOT RETURNED FOR EVALUATION. THE BATCH RECORD WAS REVIEWED AND NO ANOMALIES WERE NOTED DURING THE MANUFACTURING PROCESS.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT DURING A LAPAROSCOPIC LOBECTOMY PROCEDURE, AFTER INSERTING THE DEVICE INTO THE TROCAR, THE JAW DID NOT OPEN EVEN WHEN THE RELEASE BUTTON WAS PUSHED. THE DEVICE WAS STOPPED USING. THE JAW DID NOT OPEN AFTER FIRING. OTHER DEVICES WERE INSERTED INTO ANOTHER TROCAR AND FIRED TO REMOVE THE DEVICE CLAMPING THE TARGET TISSUE. ANOTHER DEVICE WAS USED TO COMPLETE THE CASE. THERE WERE NO ADVERSE CONSEQUENCES TO THE PATIENT. THE OPERATION WAS NOT CONVERTED TO OPEN. ADDITIONAL FOLLOWUP: THE JAW BECAME NOT TO OPEN WITH THE RELEASE BUTTON AFTER IT WAS INSERTED THROUGH A TROCAR FOR THE 1ST FIRING. THE EVENT OCCURRED BEFORE FIRING, SO THE DEVICE WAS NOT FIRED AT ALL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ECHELON 45 STAPLE, IMPLANTABLE GDW ETHICON ENDO-SURGERY, LLC. UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 ECR45G