BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UNK

    MDR report key: 330433 · Received April 30, 2001

    Report

    Report Number
    MW1021771
    Event Type
    Injury
    Date Received
    April 30, 2001
    Date of Event
    November 15, 1984
    Report Date
    April 30, 2001
    Manufacturer
    UNK
    Product Code
    EQN
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    KS, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    REC'D TUBAL LIGATION AT MEDICAL CTR. BOWEL PERFORATION OCCURRED DURING SURGERY AND WAS HOSPITALIZED AND OFF WORK FOR 6 WEEKS DUE TO EVENT. CHANNEL 41 HERE ASKED REPORTS LIKE THIS TO BE SUBMITTED TO THIS AGENCY FOR INVESTIGATION OF INSTRUMENT USED. UNSURE OF EXACT DATE OF SURGERY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    20002 UNK LAPAROSCOPIC INSTRUMENT EQN UNK * *

    Patients

    Seq Age Sex Outcome Treatment
    1 35 YR Hospitalization| L| R