MAUDE MDR 4488170

MDR report key
4488170
Report number
1045254-2015-00028
Event key
0
Event type
3
Date of event
2015-01-14
Date received
2015-02-05
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#

Contact
CHARLOTTE AYALA
Address
6743 SOUTHPOINT DR N JACKSONVILLE FL 32216 US
Phone
904-904-9043
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1NIM? ELECTRODES EMGELECTRODE, NEEDLEMEDTRONIC XOMED INC.GXZ82274108227410Y R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12015-02-050

Event Narratives#

D

Patient 1

IT WAS REPORTED ?DURING THE FACIAL NERVE DECOMPRESSION SURGERY USING THE PAIRED ELECTRODES, THE MUSCLE HAD A RESPONSE BUT IT WAS NOT SHOWN IN THE NIM. THE PROCEDURE WAS REPORTEDLY CONTINUED WITHOUT TAKING ANY ACTION FOR THIS INCIDENT, AND COMPLETED WITH NO DELAY OR ADVERSE EFFECT.? FOLLOW-UP COMMUNICATION OBTAINED ADDITIONAL INFORMATION: IT WAS NOTED THAT THE ISSUE MAY HAVE BEEN RELATED TO HOW THE ELECTRODES WERE PLACED BUT THE DOCTOR BELIEVES IT IS RELATED TO A PROBLEM WITH THE 2 CHANNEL ELECTRODES. THERE WAS NO PATIENT IMPACT OR INJURY REPORTED.

N

Patient 1

(B)(4). THIS DEVICE IS USED FOR THERAPEUTIC PURPOSES. (B)(4), NIM RESPONSE 2.0 MAINFRAME LOT/SERIAL # UNKNOWN. (B)(4): THE DEVICE HAS BEEN RECEIVED AND PRODUCT ANALYSIS IS ANTICIPATED BUT NOT YET BEGUN. METHOD ? NO TESTING METHODS PERFORMED. (B)(4).

N

Patient 1

THE DEVICE WAS RETURNED AND EVALUATED BY A QUALITY ENGINEER. RECEIVED 1 SAMPLE(S), PART NUMBER 8227410. EQUIPMENT USED: MICROSCOPE (ZEISS STEMI 2000C BETWEEN 0, 65 TO 5, 0 MAGNIFICATION SETTINGS), MULTIMETER. OBSERVATIONS: WHEN COMPARED TO THE ASSEMBLY DRAWING FOR PAIRED SUBDERMAL ELECTRODE DRAWING: END TO END RESISTANCE FOR EACH SIDE OF THE PAIRED ELECTRODES SHALL BE

N

Patient 1

IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.