BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ENDOPATH** XCEL* TROCAR

    MDR report key: 2212205 · Received August 15, 2011

    Report

    Report Number
    3005075853-2011-03309
    Event Type
    Malfunction
    Date Received
    August 15, 2011
    Date of Event
    July 14, 2011
    Report Date
    July 21, 2011
    Manufacturer
    ETHICON ENDO-SURGERY, LLC.
    Product Code
    GCJ
    PMA / PMN Number
    K032676
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FR
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). INFORMATION IS UNAVAILABLE; DEVICE WAS NOT RETURNED FOR EVALUATION.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT DURING A GASTRIC BYPASS PROCEDURE, THERE WAS LEAKAGE. AFTER ONE HOUR OF THE PROCEDURE, THE SEALS OF THE SLEEVE WERE NOT TIGHT ANYMORE; THERE WAS A GAS LEAK FROM THE SEALS. THE SURGEON WAS ANNOYED BY THIS SETBACK, HE COULD FINISH THE PROCEDURE WITHOUT CHANGING THE SLEEVE, BUT IT WAS DIFFICULT. THERE WERE NO ADVERSE CONSEQUENCES FOR THE PATIENT. ONE DEVICE WILL BE DISCARDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ENDOPATH** XCEL* TROCAR LAPAROSCOPE, GENERAL AND PLASTIC SURGERY GCJ ETHICON ENDO-SURGERY, LLC. NA H43E9N

    Patients

    Seq Age Sex Outcome Treatment
    1