BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ETHICON

    MDR report key: 2771597 · Received September 27, 2012

    Report

    Report Number
    MW5027096
    Event Type
    Injury
    Date Received
    September 27, 2012
    Date of Event
    September 26, 2012
    Report Date
    September 27, 2012
    Manufacturer
    ETHICON ENDO-SURGERY INC.
    Product Code
    FZP
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MI, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    WHILE ATTEMPTING TO CLIP THE CYSTIC ARTERY, THE TWO ARMS OF THE CLIP CROSSED, CAUSING THE ARTERY TO RUPTURE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ETHICON LIGACLIP 10-M/L FZP ETHICON ENDO-SURGERY INC. ER320 J4C91W OR J4C42C

    Patients

    Seq Age Sex Outcome Treatment
    1 71 YR Required Intervention