BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ETHICON ENDO-SURGERY INC

    MDR report key: 655819 · Received December 21, 2005

    Report

    Report Number
    MW1037259
    Event Type
    Injury
    Date Received
    December 21, 2005
    Date of Event
    December 14, 2005
    Report Date
    December 21, 2005
    Manufacturer
    ETHICON ENDO-SURGERY INC
    Product Code
    LFL
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NJ, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    BOTH STAPLERS MISFIRED: THE FIRST DID NOT CLOSE SO THE CLIPS WERE NOT PLACED CORRECTLY. THE SECOND DID NOT RELEASE PROPERLY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ETHICON ENDO-SURGERY INC ULTRACISION HARMONIC SCALPEL CURVED SHEARS LFL ETHICON ENDO-SURGERY INC P30127P17 A4C20X

    Patients

    Seq Age Sex Outcome Treatment
    1 7 MO Disability