| Brand Name | GIA |
| Common Device Name | STAPLER, SURGICAL |
| 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 | 50307145 |
| Report Number | 1219930-2026-05180 |
| Device Sequence Number | 13433881 |
| Product Code |
GAG
|
| UDI-Device Identifier | 10884521723450 |
| Combination Product (Y/N) | N |
| Initial Reporter State | CA |
| Initial Reporter Country | US |
| PMA/510(K) Number | K221006 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional,Company Representative |
| Initial Reporter Occupation |
Physician
|
| Type of Report
| Initial |
| Report Date (Section B) |
08/18/2026 |
| 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 | GIA80MTS |
| Device Catalogue Number | GIA80MTS |
| Device Lot Number | N4M1359UY |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 07/23/2026 |
| Initial Report FDA Received Date | 08/18/2026 |
| Date Device Manufactured | 12/04/2024 |
| 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 |
|
|