| Brand Name | Tri-Staple 2.0 |
| Common Device Name | STAPLE, IMPLANTABLE |
| Manufacturer (Section D) |
| Covidien Surgical |
| 60 middletown ave |
| north haven CT 06473 |
|
| Manufacturer (Section G) |
| Covidien Surgical |
| 60 middletown ave |
|
| north haven CT 06473 |
|
| Manufacturer Contact |
|
mike
bocchino
|
| 8200 coral sea st ne |
| mounds view, MN 55112--439
|
|
+1(800)646-4633
|
|
| MDR Report Key | 50219846 |
| Report Number | 1219930-2026-05026 |
| Device Sequence Number | 10316706 |
| Product Code |
GDW
|
| UDI-Device Identifier | 10884521717633 |
| UDI-Public | (01)10884521717633(17)270930(10)N4K1750Y(20)02 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | JA |
| PMA/510(K) Number | K173270 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,Health Professional,Company Representative |
| Type of Report
| Initial |
| Report Date (Section B) |
08/12/2026 |
| 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
|
| Operator of Device |
Health Professional
|
| Device Model Number | SIGTRSB60AXT |
| Device Catalogue Number | SIGTRSB60AXT |
| Device Lot Number | N4K1750Y |
| Was Device Available for Evaluation? |
Yes
|
| Date Returned to Manufacturer | 08/07/2026 |
| Is the Reporter a Health Professional? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 08/05/2026 |
| Initial Report FDA Received Date | 08/12/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 10/21/2024 |
| Is the Device Labeled for Single Use? (Y/N) |
Yes
|
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Usage of Device |
Initial
|
| Patient Sequence Number | 1 |
| Patient Sex | Unknown |
|
|