MAUDE MDR 5284950

MDR report key
5284950
Report number
1521608-2015-00005
Event key
0
Event type
3
Date of event
2015-11-05
Date received
2015-12-07
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
LYNN KELLER
Address
23700 MERCANTILE RD. BEACHWOOD OH 44122 US
Phone
216-216-2168
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1PANOSOL 3DNATIONAL BIOLOGICAL CORP.FTCUVB-631UVB-63110005R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12015-12-0701. R

Event Narratives#

N

Patient 1

THE DOCTOR'S OFFICE REPORTED THAT THE PATIENT CONFIRMED THAT HE TREATED HIMSELF WITHOUT READING THE OPERATIONS MANUAL, AND DID NOT ADHERE TO THE TREATMENT GUIDELINES SET FORTH BY HIS DOCTOR. PER THE INSTRUCTION MANUAL AND THE GUIDELINES OF THE PHYSICIAN, THE MAXIMUM TREATMENT EXPOSURE SHOULD NOT HAVE EXCEEDED 2 MINUTES AND 13 SECONDS. THE DOCTOR'S OFFICE CONFIRMED THAT THE PATIENT TREATED FOR 10 MINUTES ON BOTH THE FRONT OF HIS BODY AND ANOTHER 10 MINUTES ON THE BACK OF HIS BODY. NBC REQUESTED ACCESS TO THE DEVICE TO CONDUCT AN EVALUATION; HOWEVER, THE REQUEST FOR ACCESS WAS DENIED. THE DEVICE HAD JUST BEEN DELIVERED TO THE PATIENT, SO NBC REVIEWED THE DHR AND TEST RECORDS FOR THE DEVICE AND WAS ABLE TO CONFIRM THAT THE DEVICE WAS FUNCTION AS INTENDED 76 DAYS BEFORE THE EVENT. THE DOCTOR'S OFFICE AND NBC STRONGLY BELIEVE THAT THE PATIENT INJURY WAS CLEARLY A RESULT OF MISUSE OF INSTRUCTIONS FOR USE AS IT PERTAINS TO TREATMENT PROTOCOL.

D

Patient 1

NATIONAL BIOLOGICAL CORPORATION RECEIVED A CALL FROM A DOCTOR'S OFFICE REGARDING A PATIENT INJURY. THE PATIENT WAS USING PANOSOL 3D SYSTEM, MODEL; UVB-631 AND WAS BURNED. THE EXACT LOCATION AND DEGREE OF BURNS ARE NOT KNOWN AT THIS TIME, BUT THE DOCTOR'S OFFICE DID INFORM NBC THAT THE PATIENT WAS TREATED IN THE ICU. CURRENT STATUS OF THE PATIENT WAS NOT AVAILABLE AT THE TIME OF THIS REPORT, BUT NBC WAS ABLE TO CONFIRM THAT THE PATIENT WAS RELEASED HOME DURING A FOLLOW-UP CALL WITH THE DOCTOR'S OFFICE, ((B)(6) 2015).