MAUDE MDR 1515

MDR report key
1515
Report number
1018233-1992-00001
Event key
0
Event type
3
Date of event
1992-09-16
Date received
1992-10-05
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
999
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Report source
D
Manufacturer link flag
N

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1BARD UROLASE RIGHT ANGLE LASER FIBERLASER FIBERTRIMEDYNE, INC.LWXUNKNOWN3500007231**

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
11992-10-0501. R

Event Narratives#

D

Patient 1

IT WAS REPORTED THAT DURING A LASING PROCEDURE, THE FIBER TIP BURNED OUT AND SEPERATED FROM THE FIBER SHAFT. BIOSPY FORCEPS WERE INSERTED THROUGH THE PREVIOUSLY PLACED SCOPE AND THE TIP WAS RETRIEVED AS DESCRIBED IN THE PRODUCT LABELING. NO PATIENT INJURY OR FURTHER COMPLICATIONS WERE REPORTEDINVALID DATA - REGARDING SINGLE USE LABELING OF DEVICE. PATIENT MEDICAL STATUS PRIOR TO EVENT: UNKNOWN. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY. NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.DEVICE WAS NOT EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: NO DATA. RESULTS OF EVALUATION: NO DATA. CONCLUSION: NO DATA. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: UNKNOWN (CANNOT DETERMINE). CORRECTIVE ACTIONS: NONE OR UNKNOWN. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.