BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ETHICON ENDO-SURGERY INC.

    MDR report key: 746981 · Received November 4, 2005

    Report

    Report Number
    MW1037115
    Event Type
    Injury
    Date Received
    November 4, 2005
    Date of Event
    November 3, 2005
    Report Date
    November 4, 2005
    Manufacturer
    J & J
    Product Code
    GDO
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CO, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    SURGEON STATED THAT THE CLIP APPLIER MISFIRED SEVERAL TIMES DURING PROCEDURE. NO PATIENT HARM OR ADVERSE EFFECT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ETHICON ENDO-SURGERY INC. LIGACLIP HEMOCLIP GDO J & J MCL20 Y45J02

    Patients

    Seq Age Sex Outcome Treatment
    1 46 YR Disability