ENDO CLIP III 176630

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2020-03-29 for ENDO CLIP III 176630 manufactured by Davis & Geck Caribe Ltd.

Event Text Entries

[185495722] If information is provided in the future, a supplemental report will be issued.
Patient Sequence No: 1, Text Type: N, H10


[185495723] According to the reporter, when clipping the bile duct during a laparoscopic cholecystectomy, the clip applier fired two properly formed clips. On the third clip, the surgeon preloaded or engaged the clip and placed around the duct but the device would not fire. The jaws stayed in the engaged or preloaded position with the clip loaded. The surgeon was unable to pull clip applier out of the trocar with the jaws engaged wider than the trocar opening. They ended pulling the clip applier and trocar out together. Another trocar and clip applier was opened to complete the case. There was no patient injury.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number9612501-2020-00534
MDR Report Key9896253
Report SourceCOMPANY REPRESENTATIVE,HEALTH
Date Received2020-03-29
Date of Report2020-03-29
Date of Event2020-03-06
Date Mfgr Received2020-03-10
Device Manufacturer Date2019-09-06
Date Added to Maude2020-03-29
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactLISA HERNANDEZ
Manufacturer Street60 MIDDLETOWN AVE.
Manufacturer CityNORTH HAVEN CT 06473
Manufacturer CountryUS
Manufacturer Postal06473
Manufacturer Phone2034925563
Manufacturer G1DAVIS & GECK CARIBE LTD
Manufacturer StreetZONA FRANCA DE SAN ISIDRO
Manufacturer CitySANTO DOMINGO 0101
Manufacturer CountryDO
Manufacturer Postal Code0101
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameENDO CLIP III
Generic NameCLIP, IMPLANTABLE
Product CodeFZP
Date Received2020-03-29
Model Number176630
Catalog Number176630
Lot NumberJ9J0701Y
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Eval'ed by Mfgr*
Device Sequence No1
Device Event Key0
ManufacturerDAVIS & GECK CARIBE LTD
Manufacturer AddressZONA FRANCA DE SAN ISIDRO SANTO DOMINGO 0101 DO 0101


Patients

Patient NumberTreatmentOutcomeDate
10 2020-03-29

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