MAUDE MDR 4594

MDR report key
4594
Report number
4594
Event key
0
Event type
3
Date of event
1993-01-06
Date received
1993-02-25
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
0
Initial report to FDA
0
Event location
3

Manufacturer Contact#

Report source
U
Manufacturer link flag
N

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1FREER ELEVATORMILTEXGEGN/A18-1968NN

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
11993-02-2501. O

Event Narratives#

D

Patient 1

OTHER DEVICES USED: DYONICS ARTHROSCOPEINSTRUMENT EXPERIENCED A FITGUE FRACTURE AND TIP BROKE OFF IN THE INCISION AREA. THE TIP WAS REMOVED & INSTRUMENT WAS REMOVED FROM THE O.R. ROOM. NO FURTHER INCIDENT NOTED & NO UNTOWARD EFFECT TO PATIENTDEVICE NOT LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: SATISFACTORY CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY. NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: VISUAL EXAMINATION. RESULTS OF EVALUATION: COMPONENT FAILURE. CONCLUSION: DEVICE FAILED JUST PRIOR TO USE. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: YES. CORRECTIVE ACTIONS: NO DATA. THE DEVICE WAS DESTROYED/DISPOSED OF.