BEUDAMED
    FDA Adverse Event Other Summary report: N

    1 PROXIMATE

    MDR report key: 280056 · Received May 23, 2000

    Report

    Report Number
    280056
    Event Type
    Other
    Date Received
    May 23, 2000
    Date of Event
    March 17, 2000
    Report Date
    March 27, 2000
    Manufacturer
    ETHICON ENDO-SURGERY, INC.
    Product Code
    GCJ
    Report Source
    User Facility report
    Reporter Location
    OH, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    STAPLER DID NOT WORK WHEN PHYSICIAN ATTEMPTED TO STAPLE BOWEL. STAPLER WAS TAKEN OFF FIELD. NO PT INJURY. NEW STAPLER USED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 1 PROXIMATE RELOADABLE LINEAR CUTTER W/SAFETY LOCK-OUT GCJ ETHICON ENDO-SURGERY, INC. * M4G17K

    Patients

    Seq Age Sex Outcome Treatment
    1 73 YR Other