Brand Name | LIGAMAX ENDO CLIP APPLIER |
Type of Device | CLIP, IMPLANTABLE |
Manufacturer (Section D) |
ETHICON ENDO-SURGERY, LLC. |
475 calle c |
guaynabo PR 00969 |
|
Manufacturer (Section G) |
ETHICON ENDO-SURGERY, LLC |
475 calle c |
|
guaynabo PR 00969 |
|
Manufacturer Contact |
milton
garrett
|
4545 creek road ml 120a |
cincinnati, OH 45242
|
5133378865
|
|
MDR Report Key | 5368260 |
MDR Text Key | 36353416 |
Report Number | 3005075853-2016-00315 |
Device Sequence Number | 1 |
Product Code |
FZP
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K050344 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,user f |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
01/07/2016 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Catalogue Number | EL5ML |
Device Lot Number | M4HX06 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
01/07/2016
|
Initial Date FDA Received | 01/14/2016 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Is the Device Single Use? |
Yes
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Patient Age | 64 YR |
|
|