BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ETHICON

    MDR report key: 523162 · Received April 13, 2004

    Report

    Report Number
    MW1031834
    Event Type
    Malfunction
    Date Received
    April 13, 2004
    Date of Event
    April 9, 2004
    Report Date
    April 13, 2004
    Manufacturer
    VANGUARD MEDICAL CONCEPTS, INC.
    Product Code
    GCJ
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CO, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    LOCKING MECHANISM ON 5MM DILATING TIP TROCAR WOULD NOT WORK.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ETHICON 5MM DILATING TIP TROCAR GCJ VANGUARD MEDICAL CONCEPTS, INC. 355LD 50933

    Patients

    Seq Age Sex Outcome Treatment
    1 * Other