BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TYCO HEALTHCARE

    MDR report key: 755943 · Received August 17, 2006

    Report

    Report Number
    MW1040084
    Event Type
    Malfunction
    Date Received
    August 17, 2006
    Date of Event
    July 25, 2006
    Report Date
    July 25, 2006
    Manufacturer
    UNITED STATES SURGICAL
    Product Code
    GDO
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    AUTOSUTURE 5MM ENDLO CLIPS JAMMED WHEN FIRED THE FIRST TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TYCO HEALTHCARE 5MM ENDOCLIP GDO UNITED STATES SURGICAL 176620 N6C645

    Patients

    Seq Age Sex Outcome Treatment
    1 67 YR