BEUDAMED
    FDA Adverse Event Other Summary report: N

    ETHICON

    MDR report key: 276957 · Received April 26, 2000

    Report

    Report Number
    276957
    Event Type
    Other
    Date Received
    April 26, 2000
    Date of Event
    March 30, 2000
    Report Date
    March 31, 2000
    Manufacturer
    ETHICON ENDO-SURGERY, INC.
    Product Code
    GCJ
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    OK, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    A PIECE OF THE TROCAR SEAL BROKE OFF DURING PROCEDURE AND WAS LOST IN PT. FLUID IN SUCTION CANISTER WAS FILTERED POST-PROCEDURE - DID NOT FIND THE PIECE OF THE SEAL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ETHICON ENDOPATH TROCAR 355 GCJ ETHICON ENDO-SURGERY, INC. 355MM *

    Patients

    Seq Age Sex Outcome Treatment
    1 41 YR Other