MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05,06 report with the FDA on 2013-08-28 for FORCEPS MCEN27-2 PEDIATRIC BACKBITER [MXI] manufactured by Medtronic Xomed Instrumentation S.a.s.
[3840409]
The device (forceps mcen27-2 pediatric backbiter) was returned to mxi for service and repair. It was reported that the instrument was not working properly.
Patient Sequence No: 1, Text Type: D, B5
[10923400]
(b)(4). Analysis of the device (forceps mcen27-2 pediatric backbiter) confirmed that the metal piece broke off. It was determined that the cause for the break was physical damage. Note: this mdr is being filed as a result of an internal review of complaints from medtronic? S mxi facility in (b)(4). This review was conducted to resolve several issues discovered in the mxi complaint handling process. Issues resolved include the misclassification of devices returned for repair, as well as gaps in reporting. Mxi capa (b)(4) was opened to address these issues.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 9680837-2013-00453 |
| MDR Report Key | 3314771 |
| Report Source | 05,06 |
| Date Received | 2013-08-28 |
| Date of Report | 2011-08-31 |
| Date of Event | 2011-08-31 |
| Date Mfgr Received | 2011-08-31 |
| Date Added to Maude | 2013-11-27 |
| 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 | SHARANYA JANGITI |
| Manufacturer Street | 6743 SOUTHPOINT DRIVE NORTH |
| Manufacturer City | JACKSONVILLE FL 32216 |
| Manufacturer Country | US |
| Manufacturer Postal | 32216 |
| Manufacturer Phone | 9043328183 |
| 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 | FORCEPS MCEN27-2 PEDIATRIC BACKBITER [MXI] |
| Generic Name | FORCEPS, ENT |
| Product Code | KAE |
| Date Received | 2013-08-28 |
| Returned To Mfg | 2011-08-31 |
| Model Number | MCEN27-2 |
| Catalog Number | MCEN27-2 |
| Lot Number | NOT PROVIDED |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | MEDTRONIC XOMED INSTRUMENTATION S.A.S |
| Manufacturer Address | LE PAVILLON SAINT-AUBIN-LE-MONIAL 03160 FR 03160 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2013-08-28 |