MAUDE MDR 3622115

MDR report key
3622115
Report number
3002807818-2013-00001
Event key
0
Event type
3
Date received
2013-12-11
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
1
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Address
PO BOX 4 WEST POINT PA 19486 US
Phone
215-215-2156
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1TOF WATCH SXSTIMULATOR, NERVE, PERIPHERAL, ELECTRICORGANON IRELAND LIMITEDKOIR Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12013-12-110

Event Narratives#

N

Patient 1

THE NEUROMUSCULAR TRANSMISSION MONITOR (TOF WATCH SX) WAS AVAILABLE FOR INVESTIGATION (CURRENT LOCATION OF THE DEVICE IS (B)(6)). FOR NEUROMUSCULAR TRANSMISSION MONITOR (TOF WATCH SX), THE LOT NUMBER IS NOT AVAILABLE AND THE SERIAL NUMBER WAS REPORTED AS (B)(4). FOR NEUROMUSCULAR TRANSMISSION MONITOR (TOF WATCH SX), QUALITY INVESTIGATION STATUS: REPORTABLE MALFUNCTION/POTENTIAL INCIDENT IDENTIFIED. INVESTIGATION IN PROGRESS. ADD'L INFO IS EXPECTED.

D

Patient 1

CASE DESCRIPTION: THIS SPONTANEOUS INITIAL REPORT ORIGINATING FROM (B)(6) AS RECEIVED FROM A PHYSICIAN VIA A STUDY COORDINATOR, REFERS TO A (B)(6) FEMALE PT. THE PT WAS ENROLLED IN THE STUDY ENTITLED (B)(6) TRIAL TO COMPARE THE USE OF DEEP OR STANDARD NEUROMUSCULAR BLOCKADE IN COMBINATION WITH LOW OR STANDARD INSUFFLATION PRESSURES USING A 2X2 FACTORIAL DESIGN IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY (PROTOCOL # (B)(4) ALSO KNOWN AS (B)(4)). THIS REPORT CONCERNS ONE PT AND ONE DEVICE. THE PT USED NEUROMUSCULAR TRANSMISSION MONITOR (TOF WATCH SX) FROM (B)(6) 2013" (PRODUCT USED FOR UNK INDICATION). THE STUDY SITE RANDOMIZED THE PT ON (B)(6) 2013, BUT THERE WERE PROBLEMS WITH THE NEUROMUSCULAR TRANSMISSION MONITOR (TOF WATCH SX). THE STUDY COORDINATOR MANAGED TO DO CALIBRATION BUT AFTER THAT THEY HAD SOME DIFFICULTIES WITH TOF MEASUREMENTS AND THEN SUDDENLY IN THE TOF WATCH SCREEN APPEARED AN IMAGE OF WRENCH AND ERROR MESSAGE. THE DEVICE WAS CONNECTED TO THE PT AT THE TIME OF THE EVENT. THEN THE DEVICE TURNED OFF BY ITSELF AND DID NOT WORK ANYMORE. BEFORE THIS, NOTHING HAPPENED WHICH COULD EXPLAIN THIS HAPPENED. NEW BATTERY WAS ALSO CHANGED. THE DEVICE WAS USED ACCORDING TO THE INSTRUCTION LEAFLET. INFO ON THE OPERATOR OF THE DEVICE IS NOT REPORTED, HOWEVER, THE OPERATOR WAS TRAINED.