BEUDAMED
    FDA Adverse Event Other Summary report: N

    RE-NEW FORCEPS LAPAROSCOPIC SURGICAL TIP

    MDR report key: 3662539 · Received February 18, 2014

    Report

    Report Number
    1223422-2014-00004
    Event Type
    Other
    Date Received
    February 18, 2014
    Date of Event
    January 14, 2014
    Report Date
    February 13, 2014
    Manufacturer
    MICROLINE SURGICAL
    Product Code
    GEI
    PMA / PMN Number
    K981389
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MA, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    DURING A PROCEDURE THE DISPOSABLE RE-NEW FORCE LAPAROSCOPIC SURGICAL TIP BROKE AND FELL INTO THE PT. THE TIP WAS RETRIEVED. THIS DID NOT RESULT IN PERMANENT INJURY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    102139 RE-NEW FORCEPS LAPAROSCOPIC SURGICAL TIP MANUAL DETACHABLE SURGICAL INSTRUMENT GEI MICROLINE SURGICAL 3222 00112783

    Patients

    Seq Age Sex Outcome Treatment
    1 Other