BEUDAMED
    FDA Adverse Event Other Summary report: N

    COVIDIEN

    MDR report key: 3062768 · Received April 11, 2013

    Report

    Report Number
    MW5029759
    Event Type
    Other
    Date Received
    April 11, 2013
    Date of Event
    April 8, 2013
    Report Date
    April 11, 2013
    Manufacturer
    COVIDIEN
    Product Code
    GDW
    Report Source
    Voluntary report
    Reporter Location
    AK, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    COVIDIEN STAPLE TA90-3.5 WAS PLACED OVER TISSUE, FIRED, AND CUT. WHEN THE SURGEON (DR (B)(6)) RELEASED THE HANDLE, THE TISSUE WAS CUT, BUT THE PRODUCT DID NOT STAPLE (MISFIRED). ANOTHER STAPLER WAS OPENED AND USED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    156159 COVIDIEN STAPLER TA 9035S GDW COVIDIEN TA90355 P2H0310X

    Patients

    Seq Age Sex Outcome Treatment
    1 43 YR