BEUDAMED
    FDA Adverse Event Other Summary report: N

    AUTO SUTURE ENDO CLIP

    MDR report key: 509596 · Received February 4, 2004

    Report

    Report Number
    509596
    Event Type
    Other
    Date Received
    February 4, 2004
    Date of Event
    August 1, 2003
    Report Date
    November 1, 2003
    Manufacturer
    UNITED STATES SURGICAL CORP
    Product Code
    GDO
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    PA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    DURING A LAPAROSCOPIC PROCEDURE, THE PHYSICIAN WAS USING AN AUTOSUTURE ENDO CLIP APPLIER AND IT JAMMED DURING THE PROCEDURE. IT WAS REPLACED BY A NEW ONE AND THE CASE CONTINUED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 AUTO SUTURE ENDO CLIP CLIP APPLIER GDO UNITED STATES SURGICAL CORP 176620 N3F49

    Patients

    Seq Age Sex Outcome Treatment
    1 31 YR Other