BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PREMIUM SURGICLIP L-13.0 TITANIUM

    MDR report key: 2757062 · Received September 18, 2012

    Report

    Report Number
    2647580-2012-00591
    Event Type
    Injury
    Date Received
    September 18, 2012
    Date of Event
    July 5, 2012
    Report Date
    September 3, 2012
    Manufacturer
    COVIDIEN
    Product Code
    FZP
    PMA / PMN Number
    K853650
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FR
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). INITIAL REPORT SENT TO FDA ON 09/18/2012.

    Description of Event or Problem · 1

    ACCORDING TO THE REPORTER: A CLIP CUT A VESSEL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PREMIUM SURGICLIP L-13.0 TITANIUM DISPOSABLE CLIP APPLIER FZP COVIDIEN PIL0613X

    Patients

    Seq Age Sex Outcome Treatment
    1 Other