BEUDAMED
    FDA Adverse Event Injury Summary report: N

    COVIDIEN

    MDR report key: 2423710 · Received January 13, 2012

    Report

    Report Number
    MW5023853
    Event Type
    Injury
    Date Received
    January 13, 2012
    Date of Event
    January 12, 2012
    Report Date
    January 13, 2012
    Manufacturer
    COVIDIEN LLC
    Product Code
    GEI
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CO, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    MALFUNCTION OF COVIDIEN LIGASURE BLUNT TIP LAPAROSCOPIC SEALER/DIVIDER HANDLE DURING LAPAROSCOPIC BSO.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 COVIDIEN LIGASURE BLUNT TIP LAPAROSCOPIC SEALER/DIVIDER 5MM-37CM GEI COVIDIEN LLC REFLF1537 221976X

    Patients

    Seq Age Sex Outcome Treatment
    1 69 YR Disability AS NOTED...NO OTHER DATES APPLY.