BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ENSEAL TRIO 3MM CURVED JAW

    MDR report key: 2133537 · Received June 14, 2011

    Report

    Report Number
    MW5021020
    Event Type
    Injury
    Date Received
    June 14, 2011
    Date of Event
    June 6, 2011
    Report Date
    June 14, 2011
    Manufacturer
    ETHICON ENDO-SURGERY
    Product Code
    GEI
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    SC, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PORTION OF CURVED JAW BROKE OFF INTO PT'S ABDOMEN DURING LAPAROSCOPIC SURGERY. BROKEN PORTION OF INSTRUMENT RETRIEVED BY SURGEON.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ENSEAL TRIO 3MM CURVED JAW CURVED JAW GEI ETHICON ENDO-SURGERY H43U1N

    Patients

    Seq Age Sex Outcome Treatment
    1 41 YR Disability