ETHICON TS111

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 1993-07-13 for ETHICON TS111 manufactured by Ethicon.

Event Text Entries

[2602] When disposable trocar was removed from abdomen, a portion of the safety shield was retained. It was visualized through the scope, protruding from the peretoneum. This piece was removed and the trocar was checked tobe sure it was there in its entirety. When dr. X handed the obturator of the trocarback to me i noticed a piece was missing from the end. It was visible through the scope sticking out into the peretoneum. It was retrieved and pulled out. The rest of the obturator was inspected and was found to have another small piece inside. The incision was checked and had no other pieces. The remaining trocars removed from availability. Sales rep contacted. Rep says sthis has happened several times before and a new trocar with a reinforced shield has been manufactured. These were ordered on 6/28 to arrive 7/2. In the meantime us. Surical trocars will be used if necessary. Piece of shield removed from abdomendevice labeled for single use. Patient medical status prior to event: unknown. 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, telemetry failure, none or unknown, other. Conclusion: device failure occurred and was related to event. Certainty of device as cause of or contributor to event: invalid data. Corrective actions: device returned to manufacturer/dealer/distributor, use of all similar devices stopped permanently, other. The device was destroyed/disposed of.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number5702
MDR Report Key5702
Date Received1993-07-13
Date of Report1993-06-30
Date of Event1993-06-28
Date Facility Aware1993-06-28
Report Date1993-06-30
Date Reported to Mfgr1993-06-28
Date Added to Maude1993-07-21
Event Key0
Report Source CodeUser Facility report
Manufacturer LinkN
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag0
Health Professional0
Initial Report to FDA0
Report to FDA3
Event Location3
Single Use0
Previous Use Code0
Event Type3
Type of Report3

Device Details

Brand NameETHICON
Generic NameDISPOSABLE TROCAAR
Product CodeFBQ
Date Received1993-07-13
Model NumberTS111
Lot NumberED8459
Device Expiration Date1998-01-01
OperatorOTHER HEALTH CARE PROFESSIONAL
Device AvailabilityN
Device Age01-JUN-93
Implant FlagN
Device Sequence No1
Device Event Key5399
ManufacturerETHICON


Patients

Patient NumberTreatmentOutcomeDate
101. Required No Informationntervention 1993-07-13

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