BEUDAMED
    FDA Adverse Event Other Summary report: N

    ETHICON ENDO SURGERY, LLC

    MDR report key: 826876 · Received March 7, 2007

    Report

    Report Number
    MW1042167
    Event Type
    Other
    Date Received
    March 7, 2007
    Date of Event
    December 7, 2006
    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

    MFR DEFECT: MISFIRING AND NOT RELOADING. OPENED AND NEED ANOTHER LIGACLIP.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ETHICON ENDO SURGERY, LLC 10MM ENDOSCOPIC ROTATING MULTIPLE CLIP APPLIER GDO ETHICON ENDO SURGERY, INC. H208ER3201T C4FK2Z

    Patients

    Seq Age Sex Outcome Treatment
    1 15 YR Other