BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    WECK VISISTAT 35R 6/BOX

    MDR report key: 3021013 · Received March 20, 2013

    Report

    Report Number
    3003898360-2013-00109
    Event Type
    Malfunction
    Date Received
    March 20, 2013
    Date of Event
    February 1, 2013
    Report Date
    March 6, 2013
    Manufacturer
    TELEFLEX MEDICAL
    Product Code
    GDT
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    SAMPLE NOT RETURNED TO MFR IN TIME FOR THIS REPORT.

    Description of Event or Problem · 1

    THE EVENT IS REPORTED AS: COMPLAINT DESCRIPTION - THE STAPLER JAMMED DURING USE. NO PT INJURY REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    115804 WECK VISISTAT 35R 6/BOX SKIN STAPLER GDT TELEFLEX MEDICAL

    Patients

    Seq Age Sex Outcome Treatment
    1