BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ETHICON STAPLER

    MDR report key: 6017010 · Received October 5, 2016

    Report

    Report Number
    MW5065278
    Event Type
    Malfunction
    Date Received
    October 5, 2016
    Date of Event
    October 3, 2016
    Report Date
    October 5, 2016
    Manufacturer
    ETHICON
    Product Code
    GAG
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CO, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    STAPLER MISFIRED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    651677 ETHICON STAPLER STAPLER GAG ETHICON PSE45A N92C9T

    Patients

    Seq Age Sex Outcome Treatment
    1 76 YR