BEUDAMED
    FDA Adverse Event Other Summary report: N

    ETHICON ENDO-SURGERY INC

    MDR report key: 423700 · Received October 23, 2002

    Report

    Report Number
    423700
    Event Type
    Other
    Date Received
    October 23, 2002
    Date of Event
    October 4, 2002
    Report Date
    October 22, 2002
    Manufacturer
    ETHICON ENDO-SURGERY INC
    Product Code
    KOG
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    MI, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    ETHICON ENDOPATH-WOULD NOT LATCH CORRECTLY OR COME TOGETHER CORRECTLY ONCE HOOKED UP. RESULTED IN INABILITY TO DO EEA-ILEOSTOMY PERFORMED INSTEAD.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ETHICON ENDO-SURGERY INC ENDOPATH ILS 29MM KOG ETHICON ENDO-SURGERY INC ECSZ9 R4R04X

    Patients

    Seq Age Sex Outcome Treatment
    1 31 YR Other