TRISTAR PLASTIC SHIELD ON TROCAR/ENDOPATH LAPAROSCOPIC KIT LKR72

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 1993-08-11 for TRISTAR PLASTIC SHIELD ON TROCAR/ENDOPATH LAPAROSCOPIC KIT LKR72 manufactured by Ethicon Endo-surgery.

Event Text Entries

[3603] Two pt events. 1) during laparoscopic cholecystectomy procedure, trocar inserted and piece of plastic shield broke off and fell into pt's abdomen. No immediate post-op problems related to retained instrument noted. 2) during laparoscopic cholecstectomy procedure, portion of plastic shield trocar broke off and lodged in pt. No immediate post-op problems related to retained instrument noted. Action taken: both remaining trocars have been retained. Vendor/mfr was contacted. All same products have been removed from stock shelf in the hosp. Surgery manager requested and was sent a letter from co re: material of the safety shield and reaction of human body. Mfr verbally stated in a telephone conversation that other hosps have reported similar incidents of trocar shield's breaking. Invalid data - regarding single use labeling of device. Patient medical status prior to event: invalid data. There was multiple patient involvement. Number of patients involved: 2. Invalid data - on device service/maintenance. No data - regarding date last serviced. Service provided by: invalid data. Invalid data - service records availability. Invalid data - regarding whether event presents imminent hazard. Invalid data - whether device used as labeled/intended. Invalid data - regarding evaluation by user after event. Method of evaluation: invalid data. Results of evaluation: invalid data. Conclusion: invalid data. Certainty of device as cause of or contributor to event: invalid data. Corrective actions: no data. Invalid data - on device destroyed/disposed of status.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number6526
MDR Report Key6526
Date Received1993-08-11
Date Reported to Mfgr1993-08-06
Date Added to Maude1993-09-24
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 NameTRISTAR PLASTIC SHIELD ON TROCAR/ENDOPATH LAPAROSCOPIC KIT
Product CodeCIN
Date Received1993-08-11
Catalog NumberLKR72
Lot NumberED8562 EXP 1/98
Device Availability*
Implant Flag*
Device Sequence No1
Device Event Key6214
ManufacturerETHICON ENDO-SURGERY


Patients

Patient NumberTreatmentOutcomeDate
101. Required No Informationntervention 1993-08-11

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