BEUDAMED
    FDA Adverse Event Other Summary report: N

    ETHICON ENDO SURGERY, INC.

    MDR report key: 826787 · Received March 7, 2007

    Report

    Report Number
    MW1042169
    Event Type
    Other
    Date Received
    March 7, 2007
    Date of Event
    January 4, 2007
    Manufacturer
    ETHICON ENDO SURGERY, INC
    Product Code
    GDO
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    CLIP APPLIER MALFUNCTIONED. LOOSE CLIPS - JUST FELL OUT OF APPLIER. NEW APPLIER USED WITHOUT INCIDENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ETHICON ENDO SURGERY, INC. LIGACLIP MCA 20 LARGE TITANIUM CLIPS GDO ETHICON ENDO SURGERY, INC MULTIPLE CLIP APPLIER 33.7 CM *

    Patients

    Seq Age Sex Outcome Treatment
    1 48 YR Other