BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ENDO CLIP III

    MDR report key: 3904334 · Received June 23, 2014

    Report

    Report Number
    3904334
    Event Type
    Malfunction
    Date Received
    June 23, 2014
    Date of Event
    June 6, 2014
    Report Date
    June 23, 2014
    Manufacturer
    COVIDIEN
    Product Code
    GDO
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    UT, US

    Narratives

    Description of Event or Problem · 1

    WHEN ATTEMPTING TO FIRE THE CLIP APPLIER IT JAMMED. A SECOND APPLIER WAS OPENED AND USED WITHOUT DIFFICULTY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    366820 ENDO CLIP III APPLIER, SURGICAL, CLIP GDO COVIDIEN * N4C0053MX

    Patients

    Seq Age Sex Outcome Treatment
    1 24 YR