MAUDE MDR 5221291

MDR report key
5221291
Report number
2647580-2015-00796
Event key
0
Event type
3
Date received
2015-11-13
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
SHARON MURPHY
Address
60 MIDDLETOWN AVE NORTH HAVEN CT 06473 US
Phone
203-203-2034
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1ENDO GRASP* 5MM INSTRUMENTFORCEPS, OBSTETRICALCOVIDIEN, FORMERLY USSC PUERTO RICO INCHAD173030173030P8F0287Y R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12015-11-130

Event Narratives#

N

Patient 1

EVALUATION SUMMARY: POST MARKET VIGILANCE (PMV) LED AN EVALUATION RECEIVED ONE DEVICE OPENED BY THE ACCOUNT. THIS EVALUATION WAS BASED ON A TECHNICAL REVIEW OF ALL DATA RECEIVED FROM THE SITE, A PMV REVIEW OF MANUFACTURING RECORDS, A PMV REVIEW OF COMPLAINT TRENDS, AN ENGINEERING REVIEW OF THE PRODUCT, AND AN EVALUATION OF THE RETURNED DEVICE. UNIT WAS RECEIVED DISMANTLED WITH MISSING COMPONENTS; ONLY THE TUBE HOUSING ASSEMBLY, TRIGGER RELEASE, TRIGGER AND COVER WERE RECEIVED. GOOD WELDING WAS OBSERVED ON COVER. UNIT CONDITION PRECLUDES ANY FUNCTIONAL VERIFICATION. A REVIEW OF THE DEVICE HISTORY RECORD INDICATES THIS DEVICE LOT NUMBER WAS RELEASED MEETING ALL QUALITY RELEASE SPECIFICATIONS AT THE TIME OF MANUFACTURE. THERE WERE NO ADVERSE PATIENT EVENTS REPORTED AS A RESULT OF THE ALLEGED EVENT. SHOULD NEW INFORMATION BECOME AVAILABLE, THE FILE WILL BE RE-OPENED AND REASSESSED AT THAT TIME. (B)(4).

D

Patient 1

ACCORDING TO THE REPORTER, THE DEVICE OPENED (DISMANTLED) ENTIRELY IN SURGEON'S HANDS. THEY'D TO OPEN ANOTHER UNIT TO FINISH THE PROCEDURE. THERE WAS NO INJURY TO THE PATIENT, SINCE THIS DIDN'T HAPPENED DURING THE APPLICATION.