BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    VERRES NEEDLE

    MDR report key: 2993125 · Received February 26, 2013

    Report

    Report Number
    MW5029199
    Event Type
    Malfunction
    Date Received
    February 26, 2013
    Date of Event
    November 20, 2012
    Report Date
    February 26, 2013
    Manufacturer
    ETHICON ENDO SURGERY, LLC
    Product Code
    FHO
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CO, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    VERRES NEEDLE WOULD NOT PUSH GAS INTO ABDOMINAL CAVITY. HOSE ITSELF WAS WORKING. APPARATUS SEEMED BLOCKED. NO ADVERSE EVENT INJURY TO THE PT. REASON FOR USE: LAPAROSCOPIC LOW ANTERIOR RESECTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    81440 VERRES NEEDLE VERRES NEEDLE FHO ETHICON ENDO SURGERY, LLC J4CE99

    Patients

    Seq Age Sex Outcome Treatment
    1 73 YR