MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor,foreign report with the FDA on 2017-05-05 for BLUNTPORT PLUS 179775P manufactured by Davis & Geck Caribe Ltd.
[74530541]
Patient Sequence No: 1, Text Type: N, H10
[74530542]
According to the reporter: occurred during a laparoscopic assisted distal gastrectomy (ladg) procedure. Prior to use, a part like seal was coming out of the device. The event occurred during the procedure but the product was not used on the patient. The procedure was completed with another device. There was no patient harm. The status of the patient is no problem.
Patient Sequence No: 1, Text Type: D, B5
[77632519]
Post market vigilance (pmv) led an evaluation of one devices. The visual inspection of the returned product noted; the inner seal of the threaded anchor was disengaging from the device. The obturator, cannula and trocar were not received. The condition of the device precludes functional testing. Records from each manufacturing lot are thoroughly reviewed to ensure that products are released meeting all quality release specifications at the time of manufacture. Analysis concluded there were no assembly component related failures. Replication of the disengaged seal may occur when mishandled during clinical application. The root cause of the observed damage was misuse of the product which would have caused or contributed to the reported incident. Should new information become available, the file will be re-opened and the investigation summary will be amended as appropriate. A good faith effort will be made to obtain the applicable information relevant to the report. If information is provided in the future, a supplemental report will be issued.
Patient Sequence No: 1, Text Type: N, H10
[77632520]
According to the reporter: per additional information received the seal did not completely disengage from the device.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9612501-2017-05443 |
| MDR Report Key | 6547500 |
| Report Source | DISTRIBUTOR,FOREIGN |
| Date Received | 2017-05-05 |
| Date of Report | 2017-05-23 |
| Date of Event | 2017-04-06 |
| Date Mfgr Received | 2017-05-23 |
| Device Manufacturer Date | 2016-08-23 |
| Date Added to Maude | 2017-05-05 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | SHARON MURPHY |
| Manufacturer Street | 60 MIDDLETOWN AVENUE |
| Manufacturer City | NORTH HAVEN CT 06473 |
| Manufacturer Country | US |
| Manufacturer Postal | 06473 |
| Manufacturer Phone | 2034925267 |
| Manufacturer G1 | DAVIS & GECK CARIBE LTD |
| Manufacturer Street | ZONA FRANCA DE SAN ISIDRO |
| Manufacturer City | SANTO DOMINGO 0101 |
| Manufacturer Country | DO |
| Manufacturer Postal Code | 0101 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | BLUNTPORT PLUS |
| Generic Name | GOUGE, SURGICAL, GENERAL & PLASTIC SURGERY |
| Product Code | GDH |
| Date Received | 2017-05-05 |
| Returned To Mfg | 2017-04-24 |
| Model Number | 179775P |
| Catalog Number | 179775P |
| Lot Number | J6H2004X |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DAVIS & GECK CARIBE LTD |
| Manufacturer Address | ZONA FRANCA DE SAN ISIDRO SANTO DOMINGO 0101 DO 0101 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2017-05-05 |