FDA Adverse Event
Malfunction
Summary report: N
LIGACLIP MULTIPLE CLIP APPLIER
MDR report key: 243950
·
Received October 11, 1999
Report
- Report Number
- 1527736-1999-05296
- Event Type
- Malfunction
- Date Received
- October 11, 1999
- Report Date
- September 16, 1999
- Manufacturer
- LACEY MFG CO.
- Product Code
- GDO
- Removal / Correction Number
- NA
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- CO, US
- Reporter Occupation
- NURSE
Narratives
Description of Event or Problem · 1
IT WAS REPORTED BY THE REP THAT THE (1) EMS AND THE (1) MCM20 WERE USED DURING AN UNK PROCEDURE, BY AN UNK SURGEON, ON AN UNK DATE. THE ONLY INFO GIVEN IS THAT THE DEVICES MISFIRED. THERE WAS NO CONSEQUENCE TO THE PT. THERE IS NO OTHER INFO AVAILABLE.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | LIGACLIP MULTIPLE CLIP APPLIER | CLIP APPLIER | GDO | LACEY MFG CO. | NA | M4EW35 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | UNKNOWN | Other |