MAUDE MDR 6893665

MDR report key
6893665
Report number
3004216443-2017-00001
Event key
0
Event type
3
Date of event
2016-12-14
Date received
2017-09-26
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
MRS. SAMRADNI PATIL
Address
5340 FRYLING ROAD SUITE 101 ERIE PA 16510 US
Phone
814-814-8149
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1SHOCKPULSE LITHOTRIPSY PROBE 3.40ELECTROHYDRAULIC LITHIOTRIPTORCYBERSONICS INC.FEOSPL-PD340W1504338Y R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12017-09-260

Event Narratives#

N

Patient 1

THE SUBJECT DEVICE WAS RETURNED TO CYBERSONICS FOR INVESTIGATION. SCRATCHES WERE OBSERVED AT TIP AND CENTER OF THE PROBE. "USE OF THE SHOCKPULSE-SE DEVICE WILL ALWAYS CREATE SOME DEGREE OF METAL DEBRIS AS THE METAL PROBE VIBRATES ULTRASONICALLY AGAINST A METAL ENDOSCOPE. THIS IS KNOWN TO ALSO OCCUR WITH OTHER ULTRASONIC LITHOTRIPTERS ON THE MARKET. THE AMOUNT OF METAL DEBRIS CAN BE INCREASED DRASTICALLY IF THE USER ABUSES THE PROBE BY BENDING IT RELATIVE TO THE ENDOSCOPE." PROPER HANDLING INSTRUCTIONS OF PROBE ARE SPECIFIED IN THE INSTRUCTIONS FOR USE (IFU). IF SIGNIFICANT ADDITIONAL INFORMATION IS RECEIVED, THIS REPORT WILL BE SUPPLEMENTED.

D

Patient 1

DESCRIPTION PROVIDED BY DISTRIBUTOR. "SPL-PR340 PROBE (LOT NO. W1504338) IS USED IN A PCNL CASE PERFORMED BY UROLOGIST. THIS PHENOMENON OCCURRED DURING THE 2ND TIME OF USAGE. THE PROBE WAS UNPACKED AND ACTIVATED WITH HAND SWITCH BY A DOCTOR. DURING PROCEDURE, A SMALL GLITTER FRAGMENTS; PROBABLY A COATING OF SHOCKPULSE PROBES WAS PEEL OFF ON THE PATIENT'S KIDNEY. DOCTOR HAS REMOVED THOSE FRAGMENTS AND MOST OF THE FRAGMENTS HAVE BEEN REMOVED COMPLETELY EXCEPT FOR VERY SMALL PIECES. THE RESULT OF THE OPERATION / SURGERY WAS COMPLETED SAFELY. AFTER THE CASE, THE SUBJECTED PRODUCT HAS BEEN FOUND THAT THE SURFACE OF PROBE WAS SCRATCHED ALTHOUGH THIS CASE WAS JUST THE SECOND TIME OF USING". MODEL NO. OF PROBES MENTIONED IN COMPLAINT FROM DISTRIBUTOR: SPL-PR340 (REUSABLE). ACTUAL MODEL NO. OF PROBES SHIPPED TO DISTRIBUTOR: SPL-PDBX340 (SINGLE USE, DISPOSABLE PROBES).