BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PLEATMAN SAC TISSUE RETRIEVAL DEVICE

    MDR report key: 25709 · Received September 18, 1995

    Report

    Report Number
    MW1006933
    Event Type
    Injury
    Date Received
    September 18, 1995
    Date of Event
    August 29, 1995
    Report Date
    September 5, 1995
    Manufacturer
    CABOT MEDICAL CORP.
    Product Code
    GCJ
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Occupation
    NO INFORMATION

    Narratives

    Description of Event or Problem · 1

    SAC BROKE OFF IN PT WHILE TRYING TO RETRIEVE APPENDIX DURING LAPAROSCOPIC APPENDECTOMY. SAC RETRIEVED INTACT BY SURGEON.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PLEATMAN SAC TISSUE RETRIEVAL DEVICE TISSUE RETRIEVAL DEVICE GCJ CABOT MEDICAL CORP. 1524100

    Patients

    Seq Age Sex Outcome Treatment
    1 47 YR Required Intervention