BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CODMAN DISPOSABLE VEIN STRIPPER

    MDR report key: 492065 · Received October 28, 2003

    Report

    Report Number
    1226348-2003-00237
    Event Type
    Injury
    Date Received
    October 28, 2003
    Date of Event
    September 25, 2003
    Report Date
    September 30, 2003
    Manufacturer
    CODMAN & SHURTLEFF, INC.
    Product Code
    GAJ
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    THE VEIN STRIPPER OLIVE PULLED AWAY FROM THE REST OF THE PRODUCT AND WAS LEFT IN THE PT'S LEG. THE SURGEON MADE A LARGER INCISION TO REMOVE THE OLIVE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CODMAN DISPOSABLE VEIN STRIPPER STRIPPER, VEIN, DISPOSABLE GAJ CODMAN & SHURTLEFF, INC. NA FV496

    Patients

    Seq Age Sex Outcome Treatment
    1 30 YR Required Intervention