BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ENDOPATH ENDOSCOPIC MULTIFEED STAPLER

    MDR report key: 99351 · Received June 20, 1997

    Report

    Report Number
    1527736-1997-01380
    Event Type
    Malfunction
    Date Received
    June 20, 1997
    Date of Event
    May 28, 1997
    Report Date
    June 19, 1997
    Manufacturer
    ETHICON ENDO-SURGERY, INC.
    Product Code
    GAG
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FR
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    INFO NOT AVAILABLE, DEVICE NOT RETURNED FOR ANALYSIS. THE PRODUCT COMPLAINT ANALYSIS TEAM HAS COMPLETED ITS INVESTIGATION OF THE DEVICE WHICH WAS RETURNED TO CO WITH PRODUCT INQUIRY # 973342. VISUAL INSPECTIONS & RESULTS: HEAD ROTATES, N/A; NOSE SHROUD CRACKED/BROKEN, N/A; STAPLES IN NOSE, N/A; STAPLES IN THE TRACK, N/A AND TRIGGER ENGAGED WITH PRECOCK, N/A. FUNCTIONAL TESTS & RESULTS: CYCLED INSTRUMENT, N/A. ANALYSIS CONCLUSION: NO ANALYSIS COULD BE PERFORMED SINCE NO INSTRUMENT WAS REC'D. THE INFO YOU PROVIDED HAS BEEN NOTED AND REVIEWED WITH THE APPROPRIATE ENGINEERING AND MGF PERSONNEL. CO REVIEWS EACH INCIDENT AS IT OCCURS IN AN EFFORT TO CONTINUOUSLY IMPROVE OUR PRODUCTS AND PROCESSES.

    Description of Event or Problem · 1

    IT WAS REPORTED THE DEVICE WAS USED DURING AN UNKNOWN PROCEDURE. IT WAS REPORTED BY THE AFFILIATE THAT THE DEVICE JAMMED. THERE WAS NO PT CONSEQUENCE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ENDOPATH ENDOSCOPIC MULTIFEED STAPLER ENDOSCOPIC STAPLER GAG ETHICON ENDO-SURGERY, INC. NA K4658C

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other