BEUDAMED
    FDA Adverse Event Injury Summary report: N

    COVIDIEN

    MDR report key: 2434452 · Received January 24, 2012

    Report

    Report Number
    MW5024041
    Event Type
    Injury
    Date Received
    January 24, 2012
    Date of Event
    November 15, 2011
    Manufacturer
    COVIDIEN
    Product Code
    GDW
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    ANASTOMOTIC LEAK OCCURRED CAUSING READMISSION, MALNUTRITION DELAY IN CHEMOTHERAPY AND SIGNIFICANT PELVIC PAIN. REASON FOR USE: RECTAL CANCER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 COVIDIEN EEA 31MM STAPLE GDW COVIDIEN
    2 COVIDIEN ENDO GIA 60+45MM PURPLE STAPLE LOAD GDW COVIDIEN

    Patients

    Seq Age Sex Outcome Treatment
    1 56 YR Hospitalization| L| O