BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ENDO CATCH GOLD 10MM SPECIMEN POUCH INTL

    MDR report key: 2933400 · Received December 21, 2012

    Report

    Report Number
    9612501-2012-00087
    Event Type
    Malfunction
    Date Received
    December 21, 2012
    Report Date
    November 28, 2012
    Manufacturer
    COVIDIEN
    Product Code
    GCI
    PMA / PMN Number
    K922123
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IT
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4).

    Description of Event or Problem · 1

    PROCEDURE TYPE: ACCORDING TO THE REPORTER: THE DEVICE BROKE AND PLASTIC FRAGMENT FELL INTO PERITONEAL CAVITY. NO INJURY TO THE PATIENT BECAUSE THE FRAGMENT WAS NOTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ENDO CATCH GOLD 10MM SPECIMEN POUCH INTL SINGLE USE SPECIMEN RETRIEVAL PRODUCT GCI COVIDIEN J1L0049X

    Patients

    Seq Age Sex Outcome Treatment
    1