MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 1992-07-21 for N/A 84-42000 manufactured by Xomed - Treace.
[2057]
Surgical procedure being performed was an orbitial biopsy. When the surgeon activiated the x0med-treace cautery a spark was noted. Upon examination of the patient, it was noted by the physician that the patient had 1st and 2nd degree burns to the eyelid and the lower eyelashes had been singed offdevice labeled for single use. Patient medical status prior to event: satisfactory condition. 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: yes. Corrective actions: device permanently removed from service. The device was not destroyed/disposed of.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3083 |
| MDR Report Key | 3083 |
| Date Received | 1992-07-21 |
| Date of Report | 1992-06-01 |
| Date of Event | 1992-05-22 |
| Date Facility Aware | 1992-05-22 |
| Report Date | 1992-06-01 |
| Date Reported to Mfgr | 1992-06-01 |
| Date Added to Maude | 1993-04-06 |
| Event Key | 0 |
| Report Source Code | User Facility report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 0 |
| Health Professional | 0 |
| Initial Report to FDA | 0 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 0 |
| Previous Use Code | 0 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | N/A |
| Generic Name | HIGH TEMP CAUTERY |
| Product Code | HQR |
| Date Received | 1992-07-21 |
| Model Number | N/A |
| Catalog Number | 84-42000 |
| Lot Number | UNKNOWN |
| ID Number | N/A |
| Operator | OTHER HEALTH CARE PROFESSIONAL |
| Device Availability | Y |
| Implant Flag | N |
| Device Sequence No | 1 |
| Device Event Key | 2884 |
| Manufacturer | XOMED - TREACE |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 1992-07-21 |