BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DA VINCI

    MDR report key: 2442419 · Received February 2, 2012

    Report

    Report Number
    MW5024140
    Event Type
    Injury
    Date Received
    February 2, 2012
    Date of Event
    January 27, 2012
    Report Date
    February 2, 2012
    Manufacturer
    MICROTECK MEDICAL, INC.
    Product Code
    GCJ
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    AZ, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    WHILE DISSECTING THE RIGHT SIDE PELVIC LYMPH NODES, WITH THE ARM OF THE DA VINCI, AND ARC OCCURRED AT THE SITE OF THE TIP COVER ("TIP COVER ACCESSORY") CAUSING A SMALL HOLE IN A VESSEL. THE SURGEON REPAIRED THE INJURY WITH A STITCH.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DA VINCI TIP COVER ACCESSORY GCJ MICROTECK MEDICAL, INC. C11304

    Patients

    Seq Age Sex Outcome Treatment
    1 65 YR Disability