BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LIGACLIP

    MDR report key: 2875105 · Received December 5, 2012

    Report

    Report Number
    2875105
    Event Type
    Malfunction
    Date Received
    December 5, 2012
    Date of Event
    October 11, 2012
    Report Date
    December 5, 2012
    Manufacturer
    ETHICON ENDO-SURGERY
    Product Code
    FZP
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    NJ, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    CLIPS CROSSING EACH OTHER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LIGACLIP CLIP, IMPLANTABLE, APPLIER, ENDOSCOPIC FZP ETHICON ENDO-SURGERY * J4AH0V

    Patients

    Seq Age Sex Outcome Treatment
    1 42 YR NO OTHER THERAPIES