MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 01,07 report with the FDA on 2011-10-14 for VAUGHN SOFT TISSUE MUSHROOM PUNCH MCEN116 manufactured by Medtronic Xomed Instrumentation S.a.s..
[2341557]
It was reported that the device tip broke and could not be repaired. No add'l details about the tip breakage were provided. The mfr is not able to determine when the device broke.
Patient Sequence No: 1, Text Type: D, B5
[9369614]
This medwatch report is being filed after a retrospective review of service and repair returns for this product; we are filing this mdr for notification purposes. No medwatch form was received from the user facility, therefore, info on the medwatch form 3500a was completed by medtronic with info received from the reporter. Any missing or incomplete data on this form 3500a is the result of info not being provided or released by the reporter. Multiple attempts to obtain the required info were made, and the records of these attempts are documented in the complaint file. (b)(4). The nasal punch was returned for repair; however, the broken tip could not be repaired. The definitive cause of the reported event is unable to be determined.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 9680837-2011-00019 |
| MDR Report Key | 2313489 |
| Report Source | 01,07 |
| Date Received | 2011-10-14 |
| Date of Report | 2011-09-13 |
| Date Mfgr Received | 2011-09-13 |
| Date Added to Maude | 2012-07-06 |
| 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 | 0 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | MIKE MOSBY |
| Manufacturer Street | 6743 SOUTHPOINT DRIVE NORTH |
| Manufacturer City | JACKSONVILLE FL 32216 |
| Manufacturer Country | US |
| Manufacturer Postal | 32216 |
| Manufacturer Phone | 9042797584 |
| Manufacturer G1 | MEDTRONIC XOMED INC. |
| Manufacturer Street | 6743 SOUTHPOINT DRIVE NORTH |
| Manufacturer City | JACKSONVILLE FL 32216 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 32216 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | VAUGHN SOFT TISSUE MUSHROOM PUNCH |
| Generic Name | KAY- PUNCH, NASAL |
| Product Code | KAY |
| Date Received | 2011-10-14 |
| Returned To Mfg | 2011-02-09 |
| Model Number | NA |
| Catalog Number | MCEN116 |
| Lot Number | 0609 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | MEDTRONIC XOMED INSTRUMENTATION S.A.S. |
| Manufacturer Address | RUE LE PAVILLON SAINT AUBIN LE MONIAL BOURBON L'ARCHAMBAULT 03160 FR 03160 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2011-10-14 |