BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ETHICON ENDO-SURGERY INC

    MDR report key: 767972 · Received November 14, 2005

    Report

    Report Number
    767972
    Event Type
    Injury
    Date Received
    November 14, 2005
    Date of Event
    July 29, 2005
    Report Date
    November 1, 2005
    Manufacturer
    ETHICON ENDO-SURGERY INC.
    Product Code
    GCJ
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    NJ, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    PHYSICIAN WAS PUTTING THE LAP DISC INTO THE PT'S WOUND AND IT "JUST PULLED APART WITHOUT HARDLY ANY STRESS".

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ETHICON ENDO-SURGERY INC 1 LAP DISC GCJ ETHICON ENDO-SURGERY INC. LD 111 050303

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR Required Intervention