BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BURN SKIN STAPLER FROM STERILE BARCODE BURN PACK

    MDR report key: 2679173 · Received July 29, 2012

    Report

    Report Number
    2679173
    Event Type
    Malfunction
    Date Received
    July 29, 2012
    Date of Event
    May 14, 2012
    Report Date
    July 29, 2012
    Manufacturer
    SRI SURGICAL
    Product Code
    FSM
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    MI, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    SKIN STAPLERS STOPPED WORKING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BURN SKIN STAPLER FROM STERILE BARCODE BURN PACK STAPLER IN SURGICAL TRAY FSM SRI SURGICAL * 084894

    Patients

    Seq Age Sex Outcome Treatment
    1 23 YR