BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ETHICON ENDO-SURGERY, INC.

    MDR report key: 464230 · Received May 30, 2003

    Report

    Report Number
    MW1028595
    Event Type
    Malfunction
    Date Received
    May 30, 2003
    Date of Event
    May 16, 2003
    Report Date
    May 21, 2003
    Manufacturer
    ETHICON ENDO-SURGERY, INC.
    Product Code
    GAG
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    STAPLER WITH 6 ROW RELOAD MISFIRED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ETHICON ENDO-SURGERY, INC. LONG 45 ENDOCUTTER GAG ETHICON ENDO-SURGERY, INC. 45A T4VVR4F

    Patients

    Seq Age Sex Outcome Treatment
    1 59 YR Other