BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LIGACLIP MULTIPLE CLIP APPLIER

    MDR report key: 250510 · Received November 16, 1999

    Report

    Report Number
    1527736-1999-05891
    Event Type
    Malfunction
    Date Received
    November 16, 1999
    Date of Event
    October 21, 1999
    Report Date
    October 21, 1999
    Manufacturer
    LACEY MANUFACTURING CO.
    Product Code
    GDO
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FR
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED BY THE AFFILIATE THAT THE (1) MCM30 WAS USED DURING AN UNKNOWN PROCEDURE. IT WAS REPORTED THAT THE CLIPS WOULD NOT FEED. THE CASE WAS COMPLETED WITH ANOTHER INSTRUMENT AND THERE WAS NO CONSEQUENCE TO THE PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LIGACLIP MULTIPLE CLIP APPLIER CLIP APPLIER GDO LACEY MANUFACTURING CO. NA M4FF29

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other