PULSAR GENERATOR MAE UNK PEAK GEN

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05,06,health professional,use report with the FDA on 2014-07-17 for PULSAR GENERATOR MAE UNK PEAK GEN manufactured by Medtronic Advanced Energy, Llc.

Event Text Entries

[19718515] During a tonsil and adenoidectomy case the plasmablade tna device (adenoid tip) sparked. The generator settings at the time of the spark were coag 8, cut 1, but the oxygen setting was unknown. No patient impact (patient details refused to be given by user facility). *due to the fact that the generator could not be ruled out as the cause or a contributing factor to the reported incident it is deemed reportable
Patient Sequence No: 1, Text Type: D, B5


[19858285] Product event (b)(4). Method, results, conclusion: generator not returned therefore analysis unable to be performed. (b)(4).
Patient Sequence No: 1, Text Type: N, H10


[103812033] If information is provided in the future, a supplemental report will be issued.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number1226420-2014-00051
MDR Report Key3942008
Report Source05,06,HEALTH PROFESSIONAL,USE
Date Received2014-07-17
Date of Report2014-06-18
Date of Event2014-06-18
Date Mfgr Received2014-06-18
Date Added to Maude2014-07-31
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactKAYLEE BOISVERT
Manufacturer Street180 INTERNATIONAL DRIVE
Manufacturer CityPORTSMOUTH NH 03801
Manufacturer CountryUS
Manufacturer Postal03801
Manufacturer Phone6038426234
Manufacturer G1MEDTRONIC ADVANCED ENERGY, LLC
Manufacturer Street180 INTERNATIONAL DRIVE
Manufacturer CityPORTSMOUTH NH 03801
Manufacturer CountryUS
Manufacturer Postal Code03801
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NamePULSAR GENERATOR
Generic NameGENERATOR,ELECTROSURGICAL,COAGULATION,CANCER
Product CodeMUL
Date Received2014-07-17
Model NumberMAE UNK PEAK GEN
Catalog NumberMAE UNK PEAK GEN
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrN
Device Sequence No1
Device Event Key0
ManufacturerMEDTRONIC ADVANCED ENERGY, LLC
Manufacturer Address180 INTERNATIONAL DRIVE PORTSMOUTH NH 03801 US 03801


Patients

Patient NumberTreatmentOutcomeDate
10 2014-07-17

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