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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ETHICON ENDO-SURGERY, LLC. ENDOPATH*STEALTH CIR STAPLER (EXACT CODE UNKNOWN) LAPAROSCOPE, GENERAL AND PLASTIC SURGERY

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ETHICON ENDO-SURGERY, LLC. ENDOPATH*STEALTH CIR STAPLER (EXACT CODE UNKNOWN) LAPAROSCOPE, GENERAL AND PLASTIC SURGERY Back to Search Results
Catalog Number ILSX
Device Problem Adverse Event Without Identified Device or Use Problem (2993)
Patient Problems Peritonitis (2252); No Code Available (3191)
Event Type  Injury  
Manufacturer Narrative

(b)(4). Date of event: only event year known: 2019. Batch # unknown. Attempts have been made to retrieve the device. To date the device has not been returned. If the device or further details are received at a later date a supplemental medwatch will be sent. The lot/batch was not provided; therefore, the manufacturing records could not be reviewed. The following information was requested, but unavailable: is the product code or lot number of the device available? were there any issues experienced with the device in the initial surgical procedure? where in the green gap setting scale was the indicator located prior to firing (low-b, middle-b, or high-b)? did the healthcare professional wait 15 seconds after closing the device and then retighten prior to firing? was the device difficult to close? was the device difficult to fire? did the healthcare professional receive audible & tactile feedback when firing the device? were the donuts inspected? if so, please describe. Was a complete transection of the white breakaway washer visually confirmed? was a leak test performed? if so, what was the result? how many days postoperative did the leak occur? how was leak identified? can more information be provided on what was meant by. ¿complete release of the anastomosis at j 3¿? were malformed staples identified? if so, please describe the shape and location. Is the colostomy temporary or permanent? what is the current status of the patient?.

 
Event Description

It was reported that during a rectum procedure, when i operated on a patient on (b)(6) 2019 for upper rectum cancer. This patient had an anterior resection of the rectum followed by a colorectal anastomosis with the circular mechanical clamp and the consequences are unfortunately ended by a complete release of the anastomosis at j3. The patient was resumed for postoperative peritonitis and had peritoneal lavage and extraction of a hartmann colostomy.

 
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Type of DeviceLAPAROSCOPE, GENERAL AND PLASTIC SURGERY
Manufacturer (Section D)
ETHICON ENDO-SURGERY, LLC.
475 calle c
guaynabo 00969
Manufacturer (Section G)
ETHICON ENDO-SURGERY, LLC.
475 calle c
guaynabo 00969
Manufacturer Contact
milton garrett
475 calle c
guaynabo 00969
5133378865
MDR Report Key8806968
MDR Text Key151580486
Report Number3005075853-2019-20515
Device Sequence Number1
Product Code GCJ
Combination Product (Y/N)N
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type FOREIGN
Reporter Occupation
Type of Report Initial
Report Date 06/23/2019
1 Device Was Involved in the Event
0 PatientS WERE Involved in the Event:
Date FDA Received07/19/2019
Is This An Adverse Event Report? Yes
Is This A Product Problem Report? No
Device Operator HEALTH PROFESSIONAL
Device Catalogue NumberILSX
Was Device Available For Evaluation? No
Is The Reporter A Health Professional?
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received06/23/2019
Was Device Evaluated By Manufacturer? Device Not Returned To Manufacturer
Is The Device Single Use? No Answer Provided
Is this a Reprocessed and Reused Single-Use Device?
Type of Device Usage Initial

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