BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LIGACLIP MCA

    MDR report key: 3001489 · Received February 25, 2013

    Report

    Report Number
    3001489
    Event Type
    Malfunction
    Date Received
    February 25, 2013
    Date of Event
    January 31, 2013
    Report Date
    February 5, 2013
    Manufacturer
    ETHICON ENDO-SURGERY, INC.
    Product Code
    GDO
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    MO, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    THE FIRST CLIP JAMMED WHILE TRYING TO DISCHARGE FROM THE DEVICE. IT WAS STUCK ON THE VESSEL, BUT AFTER MUCH MANIPULATION, IT WAS ABLE TO BE FULLY DISCHARGED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    79191 LIGACLIP MCA APPLIER, SURGICAL, CLIP GDO ETHICON ENDO-SURGERY, INC. MSM20 *

    Patients

    Seq Age Sex Outcome Treatment
    1 57 YR