BEUDAMED
    FDA Adverse Event Death Summary report: N

    MANUAL ENDOSCOPIC ROTATIONAL CLIP APPLIER

    MDR report key: 91125 · Received May 16, 1997

    Report

    Report Number
    1044475-1997-00005
    Event Type
    Death
    Date Received
    May 16, 1997
    Date of Event
    May 1, 1997
    Report Date
    May 9, 1997
    Manufacturer
    WECK CLOSURE SYSTEMS, LLC
    Product Code
    HBT
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MX
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    DEATH OCCURRED FROM POSSIBLE CLIP CLOSURE FAILURE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MANUAL ENDOSCOPIC ROTATIONAL CLIP APPLIER MANUAL CLIP APPLIER HBT WECK CLOSURE SYSTEMS, LLC * *

    Patients

    Seq Age Sex Outcome Treatment
    1 NO INFO Death