BEUDAMED
    FDA Adverse Event Other Summary report: N

    ETHICON ECS29

    MDR report key: 2150769 · Received June 23, 2011

    Report

    Report Number
    MW5021230
    Event Type
    Other
    Date Received
    June 23, 2011
    Date of Event
    June 19, 2011
    Report Date
    June 22, 2011
    Manufacturer
    ETHICON ENDO-SURGERY, LLC
    Product Code
    GDW
    Report Source
    Voluntary report
    Reporter Location
    KY, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    ANASTOMOSIS STAPLER MALFUNCTION. NO HARM TO PT. ANOTHER STAPLER WAS OBTAINED AND PROCEDURE COMPLETE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ETHICON ECS29 ECS29 ANASTOMOSIS STAPLER GDW ETHICON ENDO-SURGERY, LLC ECS29

    Patients

    Seq Age Sex Outcome Treatment
    1 33 YR Other