BEUDAMED
    FDA Adverse Event Other Summary report: N

    ETHICON

    MDR report key: 501357 · Received October 27, 2003

    Report

    Report Number
    501357
    Event Type
    Other
    Date Received
    October 27, 2003
    Date of Event
    December 1, 2002
    Report Date
    May 1, 2003
    Manufacturer
    ETHICON ENDO SURGERY, INC.
    Product Code
    LFL
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    WI, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    A SMALL PIECE OF TITANIUM BROKE OFF OF INSTRUMENT. SURGEON SEARCHED SITE BUT PIECE WAS NOT FOUND.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ETHICON HARMONIC SCALPEL CURVED SHEERS LFL ETHICON ENDO SURGERY, INC. * R4UR6P

    Patients

    Seq Age Sex Outcome Treatment
    1 58 YR