BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    AUTOSUTURE ENDO CLIP III 5MM

    MDR report key: 2161237 · Received July 8, 2011

    Report

    Report Number
    2161237
    Event Type
    Malfunction
    Date Received
    July 8, 2011
    Date of Event
    June 28, 2011
    Report Date
    July 8, 2011
    Manufacturer
    COVIDIEN AUTOSUTURE
    Product Code
    FZP
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    UT, US

    Narratives

    Description of Event or Problem · 1

    THE DEVICE WOULD NOT RELEASE CLIPS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 AUTOSUTURE ENDO CLIP III 5MM CLIP APPLIER FZP COVIDIEN AUTOSUTURE 176630 N1D0136

    Patients

    Seq Age Sex Outcome Treatment
    1 40 YR