BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    COVIDIEN

    MDR report key: 4342830 · Received December 11, 2014

    Report

    Report Number
    MW5039640
    Event Type
    Malfunction
    Date Received
    December 11, 2014
    Date of Event
    December 1, 2014
    Report Date
    December 3, 2014
    Manufacturer
    COVIDIEN
    Product Code
    GDO
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    FIVE MM ENDOCLIP DEVICE BECAME JAMMED DURING PROCEDURE AND WOULD NOT FUNCTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    803936 COVIDIEN ENDO CLIP III 5 MM GDO COVIDIEN N4K1039MX

    Patients

    Seq Age Sex Outcome Treatment
    1 73 YR