BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BOWEL GRASPER

    MDR report key: 5515867 · Received March 17, 2016

    Report

    Report Number
    MW5061015
    Event Type
    Malfunction
    Date Received
    March 17, 2016
    Date of Event
    March 1, 2016
    Report Date
    March 17, 2016
    Manufacturer
    STORZ
    Product Code
    GCJ
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NY, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    DURING SCHEDULED LAP APPENDECTOMY, SURGEON NOTICED ONE SIDE OF 3 CM JAW OF BOWEL GRASPER WAS MISSING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    163308 BOWEL GRASPER BOWEL GRASPER GCJ STORZ 33132 GC03

    Patients

    Seq Age Sex Outcome Treatment
    1 26 YR