BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ETHICON ENDO-SURGERY

    MDR report key: 2468885 · Received February 21, 2012

    Report

    Report Number
    MW5024376
    Event Type
    Injury
    Date Received
    February 21, 2012
    Date of Event
    September 19, 2011
    Report Date
    February 21, 2012
    Manufacturer
    ETHICON QC LABS
    Product Code
    FZP
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MO, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    PHYSICIAN WAS PERFORMING A LAPAROSCOPIC CHOLECYSTECTOMY WITH INTRAOPERATIVE CHOLANGIOGRAMS. ACCORDING TO PHYSICIAN THE ETHICON ENDOSCOPIC CLIP APPLIER WOULD NOT WORK PROPERLY. PLEASE NOTE THAT ON (B)(6) 2012 THIS SAME REPORT WAS PLACED BUT INADVERTENTLY ASSIGNED TO COVIDIEN-U.S. SURGICAL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ETHICON ENDO-SURGERY ENDO CLIP 5MM FZP ETHICON QC LABS 176620 N0M0167

    Patients

    Seq Age Sex Outcome Treatment
    1 22 YR Disability