BEUDAMED
    FDA Adverse Event Other Summary report: N

    ETHICON

    MDR report key: 496682 · Received November 6, 2003

    Report

    Report Number
    MW1030133
    Event Type
    Other
    Date Received
    November 6, 2003
    Report Date
    November 6, 2003
    Manufacturer
    ETHICON ENDO SURGERY, INC.
    Product Code
    KOG
    Report Source
    Voluntary report
    Reporter Location
    CO, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    ENDOSURGERY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ETHICON ENDOPOUCH RETRIEVER X2 KOG ETHICON ENDO SURGERY, INC. * T4W99E

    Patients

    Seq Age Sex Outcome Treatment
    1 34 YR Other