BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ETHICON ENDO-SURGERY, INC

    MDR report key: 2787992 · Received October 5, 2012

    Report

    Report Number
    MW5027218
    Event Type
    Malfunction
    Date Received
    October 5, 2012
    Date of Event
    May 29, 2012
    Report Date
    October 5, 2012
    Manufacturer
    ETHICON ENDO SURGERY
    Product Code
    GCJ
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    FL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    DR. (B)(6) WAS INSERTING TROCARS FOR A LAP VENTRAL HERNIA WHEN THE TROCAR HE WAS INSERTING BROKE INTO PIECES AND SOME OF THE PIECES HAD TO BE RETRIEVED FROM ABDOMEN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ETHICON ENDO-SURGERY, INC XCEL BLUNT TIP TROCAR GCJ ETHICON ENDO SURGERY H12LP 1725750

    Patients

    Seq Age Sex Outcome Treatment
    1 84 YR