MAUDE MDR 3021187

MDR report key
3021187
Report number
1045254-2013-00300
Event key
0
Event type
3
Date received
2013-03-26
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MICHELLE ALFORD
Address
6743 SOUTHPOINT DRIVE NORTH JACKSONVILLE FL 32216 US
Phone
904-904-9043
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1PUNCH 3712038 CUTTING CIRCULAR 3.5MMPUNCH, NASALMEDTRONIC XOMED, INC.KAY37120383712038201201MF1Y R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12013-03-260

Event Narratives#

N

Patient 1

DEVICE RECEIVED (B)(4) 2013. EVALUATION SUMMARY: PRODUCT ANALYSIS FOUND THAT THE CONDITION OF THE RETURNED DEVICE SHOWED CUSTOMER USE. FROM VISUAL EVALUATION, THE SHAFT AT THE TIP WAS FOUND BROKEN APPROXIMATELY 11MM FROM THE DISTAL TIP. UNDER MAGNIFICATION, THE BROKEN SHAFT EDGES WERE FOUND JAGGED. THE OUTER DIAMETER OF THE SHAFT WAS FOUND APPROXIMATELY 2.70MM WHICH IS MEETS THE REQUIRED SPECIFICATION OF 2.70MM +/- 0.50 AS PER ASSEMBLY DRAWING. THE TIP (PUNCH) OUTER DIAMETER MEASURED 3.49MM WHICH ALSO MEETS THE SPECIFICATION OF 3.50MM +/- 0.50MM. THE OVERALL LENGTH COULD NOT BE MEASURED DUE TO THE BROKEN SHAFT COMPONENT. THE DEVICE COULD NOT BE FUNCTIONED UPON ACTIVATION OF HANDLE DUE TO BROKEN SHAFT ASSEMBLY. THE BREAKAGE OF THE SHAFT APPEARS TO BE RELATED WITH EXCESSIVE CUSTOMER HANDLING / USE OF THE DEVICE DURING PROCEDURE. METHOD: MICROSCOPIC INSPECTION. (B)(4).

D

Patient 1

IT WAS REPORTED THAT THERE IS A PIECE THAT IS EITHER BROKEN OR MISSING FROM THE DEVICE. NO REPORTED PATIENT IMPACT.

N

Patient 1

THIS DEVICE IS USED FOR THERAPEUTIC PURPOSES. (B)(4): EVALUATION SUMMARY NOT AVAILABLE, DEVICE HAS NOT BEEN RETURNED OR EVALUATED AT THIS TIME. METHOD: ACTUAL DEVICE NOT EVALUATED.

N

Patient 1

IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.