MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2012-12-13 for EXCEL B12LT * manufactured by Ethicon Endosurgery, Inc..
[3108343]
Co2 insufflation leak noted with and without presence of instrumentation in trocar. Replaced device with a new one.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2897671 |
| MDR Report Key | 2897671 |
| Date Received | 2012-12-13 |
| Date of Report | 2012-12-12 |
| Date of Event | 2012-12-12 |
| Report Date | 2012-12-12 |
| Date Reported to FDA | 2012-12-13 |
| Date Added to Maude | 2013-01-07 |
| Event Key | 0 |
| Report Source Code | User Facility report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 0 |
| Previous Use Code | 0 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | EXCEL |
| Generic Name | ENDOSCOPIC ACCESSORY |
| Product Code | MFJ |
| Date Received | 2012-12-13 |
| Model Number | B12LT |
| Catalog Number | * |
| Lot Number | * |
| ID Number | * |
| Operator | UNKNOWN |
| Device Availability | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ETHICON ENDOSURGERY, INC. |
| Manufacturer Address | 4545 CREEK ROAD, CINCINNATI OH 45242283 US 45242 2839 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2012-12-13 |