BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ORIGIN

    MDR report key: 259641 · Received January 20, 2000

    Report

    Report Number
    259641
    Event Type
    Injury
    Date Received
    January 20, 2000
    Date of Event
    January 12, 2000
    Report Date
    January 19, 2000
    Manufacturer
    ORIGIN MEDISYSTEMS, INC.
    Product Code
    GCJ
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CT, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    CLASSIC TIP TROCAR FROM LAP HERNIA KIT BROKE WHEN IN PT. BROKEN PIECE RETRIEVED BY SURGEON.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ORIGIN TROCAR (OMS - P1 - TSS KIT) GCJ ORIGIN MEDISYSTEMS, INC. 0086 0909991

    Patients

    Seq Age Sex Outcome Treatment
    1 73 YR Required Intervention