BEUDAMED
    FDA Adverse Event Death Summary report: N

    VERSAPOINT

    MDR report key: 602786 · Received May 16, 2005

    Report

    Report Number
    2210968-2005-00294
    Event Type
    Death
    Date Received
    May 16, 2005
    Date of Event
    April 5, 2005
    Report Date
    April 18, 2005
    Manufacturer
    ETHICON, INC.
    Product Code
    JOS
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    UK
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    PATIENT UNDERWENT A POLYPECTOMY OUTPATIENT PROCEDURE IN 2005. THREE TO FOUR POLYPS WERE REMOVED. TOWARDS THE END OF THE PROCEDURE, THE PATIENT FELT UNCOMFORTABLE WITH LOWER ABDOMINAL PAIN. THE PROCEDURE LENGTH WAS 20 MINUTES. FOLLOWING THE PROCEDURE, THE PATIENT WAS DISCHARGED WITH NO APPARENT COMPLICATIONS. PATIENT WAS RE ADMITTED THE NEXT DAY AND EXPIRED THE FOLLOWING DAY. A PERFORATION OF THE MID REGION OF THE SMALL BOWEL IN THE AREA DIRECTLY OVERLYING THE FUNDUS OF THE UTERUS WAS NOTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 VERSAPOINT ELECTRODE JOS ETHICON, INC. NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 80 YR Death