BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ETHICON

    MDR report key: 5404790 · Received August 14, 2003

    Report

    Report Number
    5404790
    Event Type
    Malfunction
    Date Received
    August 14, 2003
    Date of Event
    July 29, 2003
    Report Date
    July 29, 2003
    Manufacturer
    ETHICON (J AND J)
    Product Code
    FZP
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    LA, US
    Reporter Occupation
    2

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ETHICON LAP CHOLE KIT (ENDO CLIP APPLIER) FZP ETHICON (J AND J) A92482P00

    Patients

    Seq Age Sex Outcome Treatment
    1 32 YR Other