BEUDAMED
    FDA Adverse Event Summary report: N

    ECS 25MM STAPLER

    MDR report key: 3001709 · Received March 8, 2013

    Report

    Report Number
    MW5029326
    Date Received
    March 8, 2013
    Date of Event
    February 28, 2013
    Report Date
    March 1, 2013
    Manufacturer
    ETHICON
    Product Code
    GDW
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    ROBOTIC ASSISTED LAP CONVERTED TO OPEN SIGMOIDECTOMY DUE TO MALFUNCTION OF STAPLER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    98619 ECS 25MM STAPLER GDW ETHICON F5VY5C 1043

    Patients

    Seq Age Sex Outcome Treatment
    1 64 YR Required Intervention