BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ETHICON ENDO-SURGERY INC.

    MDR report key: 507460 · Received January 20, 2004

    Report

    Report Number
    507460
    Event Type
    Malfunction
    Date Received
    January 20, 2004
    Date of Event
    January 5, 2004
    Report Date
    January 16, 2004
    Manufacturer
    ETHICON ENDO-SURGERY INC.
    Product Code
    KOG
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    NJ, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    STAPLER DID NOT FIRE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ETHICON ENDO-SURGERY INC. LIGACLIP MCA MULTIPLE CLIP APPLIER 23.8 CM KOG ETHICON ENDO-SURGERY INC. MCS20 T4YG40

    Patients

    Seq Age Sex Outcome Treatment
    1 43 YR Other