MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 07 report with the FDA on 2008-07-03 for MAST QUADRANT RETRACTOR SYSTEM 9560658 manufactured by Warsaw Orthopedic Inc..
[891325]
It was reported that the light source cable overheated during surgery and the pt was burned. It was reported that more than the recommended 100w was used with the light source. No further complications were reported.
Patient Sequence No: 1, Text Type: D, B5
[8080938]
The device has not been returned to medtronic for evaluation.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1030489-2008-00307 |
| MDR Report Key | 1069613 |
| Report Source | 07 |
| Date Received | 2008-07-03 |
| Date of Report | 2008-06-04 |
| Date of Event | 2008-06-04 |
| Date Mfgr Received | 2008-06-04 |
| Date Added to Maude | 2008-07-10 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| 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 | 0 |
| Event Location | 0 |
| Manufacturer Contact | CHAD ASHTON |
| Manufacturer Street | 1800 PYRAMID PLACE |
| Manufacturer City | MEMPHIS TN 38132 |
| Manufacturer Country | US |
| Manufacturer Postal | 38132 |
| Manufacturer Phone | 9013963133 |
| Manufacturer G1 | WARSAW ORTHOPEDIC INC. |
| Manufacturer Street | 2500 SILVEUS CROSSING |
| Manufacturer City | WARSAW IN 46852 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 46852 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | MAST QUADRANT RETRACTOR SYSTEM |
| Generic Name | ILLUMINATION SYSTEM |
| Product Code | FSZ |
| Date Received | 2008-07-03 |
| Model Number | NA |
| Catalog Number | 9560658 |
| Lot Number | UNK |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Implant Flag | N |
| Date Removed | B |
| Device Sequence No | 1 |
| Device Event Key | 1037921 |
| Manufacturer | WARSAW ORTHOPEDIC INC. |
| Manufacturer Address | 2500 SILVEUS CROSSING WARSAW IN 46852 US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2008-07-03 |