BEUDAMED
    FDA Adverse Event Injury Summary report: N

    JARIT

    MDR report key: 290927 · Received August 14, 2000

    Report

    Report Number
    2430952-2000-00003
    Event Type
    Injury
    Date Received
    August 14, 2000
    Date of Event
    August 3, 2000
    Report Date
    August 14, 2000
    Manufacturer
    KOSCHER & WUERTZ GMBH, CHIRURGISCHE INSTRUMENTE
    Product Code
    GCJ
    Product Problem
    Yes
    Report Source
    Distributor report
    Reporter Location
    MI, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    DURING THE PERFORMANCE OF A LAPAROSCOPIC CHOLECYSTECTOMY PROCEDURE, THE TIP OF A 5MM DOUBLE CUP GRASPER BROKE OFF, FALLING INTO THE OPERATIVE SITE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 JARIT 5MM DOUBLE CUP GRASPER GCJ KOSCHER & WUERTZ GMBH, CHIRURGISCHE INSTRUMENTE 625-108 *

    Patients

    Seq Age Sex Outcome Treatment
    1 93 YR Required Intervention