FUTURA PRO USFPC1

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2014-06-03 for FUTURA PRO USFPC1 manufactured by Ultratone Scientific Instruments, Ltd.

Event Text Entries

[4579938] (b)(6) 2014, around 8pm cst: futura pro demo performed by u. S. Sales rep (b)(4) on physician/pt at his home; 15 minutes of abdominal/flank area ultrasound cavitation using conduction gel; followed by 8 tens unit pads placed on skin in abdominal/flank area x 40 minutes. Treatment with intensity initially controlled by sales rep then turned over to physician/pt; sales rep performing demo indicated the futura pro was completely safe. No informed consent forms or contraindications were discussed. Sales rep conducted demonstration on physician/pt to promote sale of unit for (b)(4) usd for use in his cosmetic surgery practice for "off label" use since the 510k was not yet approved for "weight loss in pts in u. S. " for either the muscle stimulator or the ultrasound portions. (b)(6) (evening) until (b)(6) physician/patient experienced daily symptoms of progressive abdominal fullness, distension, vague digestion, and early satiety following minimal food intake. (b)(6) around 7pm cst: abdominal fullness, distension, and pain began to intensify with complete cessation of flatus, nausea experienced by physician/pt. (b)(6) around 3am cst: physician/pt experienced full spectrum of symptoms for a complete bowel obstruction and presented himself to hospital for evaluation in the ed. (b)(6) at hospital: eval of physician/pt revealed a complete bowel obstruction on 64-slice ct scan with iv contrast. No masses or tumors were detected. Ngt placed to low intermittent wall suction. General surgery and hospitalist consultations were done. Npo status with iv pain meds and complete bowel rest were implemented. (b)(6) at hospital: finally, after 3 episodes of flatus the ng tube was removed thereby allowing an upper gi barium swallow study with small bowel follow through to be done with barium contrast showing a completely normal study. (b)(6): physician/pt was discharged from hospital to home with resolution of complete small bowel obstruction. On hospital discharge summary, all three consulting general and trauma surgeons caring for this physician/pt referenced a probable link to a (b)(6) medical device demo. One of the surgeons stated "possible paralytic segment of bowel from recent tens. "
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report NumberMW5037228
MDR Report Key3932746
Date Received2014-06-03
Date of Report2014-06-02
Date of Event2014-05-07
Date Added to Maude2014-07-15
Event Key0
Report Source CodeVoluntary report
Manufacturer LinkN
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA0
Event Location0
Single Use0
Previous Use Code0
Event Type3
Type of Report3

Device Details

Brand NameFUTURA PRO
Generic NameNONE
Product CodeIMG
Date Received2014-06-03
Model NumberUSFPC1
OperatorLAY USER/PATIENT
Device Sequence No1
Device Event Key0
ManufacturerULTRATONE SCIENTIFIC INSTRUMENTS, LTD
Manufacturer AddressASHFORD, KENT TN236LN TN23 6LN


Patients

Patient NumberTreatmentOutcomeDate
101. Hospitalization; 2. Life Threatening; 3. Required No Informationntervention 2014-06-03

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