INNER SHEATH 8655.384

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2017-10-10 for INNER SHEATH 8655.384 manufactured by Richard Wolf Germany (rwgmbh).

Event Text Entries

[89230201] Richard wolf medical instruments cooperation (rwmic) was informed by one of its sales representatives that during a procedure the device in question broke off inside of patient. Procedure completed as scheduled. No injury to patient or staff reported. Device approximately (b)(4) years old. Facility has been contacted, via phone and email, in an effort to gather additional/missing for medwatch report. No response received as of (b)(6) 2017. There have been two similar complaints have been reported last three years (mdr 1418479-2015-0027 and 1418479-2015-00029). Instructions for use (ifu) contains the following: 7 use caution! The products have only limited strength! Excessive force will cause damage, impair the function and therefore endanger the patient. Immediately before and after each use, check the products for damage, loose parts and completeness. Make sure that no missing parts remain in the patient. Do not use the products if they are damaged or incomplete or have loose parts. 7. 2. 5 hf application warning! Activate hf instruments only after the live part conducting hf current has become fully visible in the field of view of the endoscope and touches the intended area to be treated. 8. 1 checks caution! Be careful if products are damaged or incomplete. Injuries of the patient, user or others are possible. Run through the checks before and after each use. Do not use the products if they are damaged, incomplete or have loose parts. Return damaged products together with any loose parts for repair. Do not attempt to do any repairs yourself. Device has not been returned. If rwmic receives device, it will be sent to manufacturer for investigation. Rwmic considers this report closed. If rwmic receives additional information regarding this incident, a follow up report will be sent to the fda.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1418479-2017-00028
MDR Report Key6935719
Date Received2017-10-10
Date of Report2017-09-29
Date of Event2017-09-29
Date Facility Aware2017-09-27
Report Date2017-10-10
Date Reported to FDA2017-10-10
Date Reported to Mfgr2017-10-10
Date Added to Maude2017-10-10
Event Key0
Report Source CodeDistributor report
Manufacturer LinkN
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Single Use3
Previous Use Code3
Event Type3
Type of Report0

Device Details

Brand NameINNER SHEATH
Generic NameSHEATH
Product CodeFDC
Date Received2017-10-10
Model Number8655.384
Catalog Number8655.384
Lot Number1208503
OperatorPHYSICIAN
Device AvailabilityN
Device Age4 YR
Device Eval'ed by Mfgr*
Device Sequence No1
Device Event Key0
ManufacturerRICHARD WOLF GERMANY (RWGMBH)
Manufacturer AddressREGISTRATION NUMBER 9611102 32 PFORZHEIMER STREET KNITTLINGEN, 75438 GM 75438


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2017-10-10

© 2024 FDA.report
This site is not affiliated with or endorsed by the FDA.