MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2017-12-21 for JAW INS.MICRO-DISSECTOR SCISS 5MM 310MM PO602R manufactured by Aesculap Ag.
[95619545]
(b)(4). Manufacturing site evaluation: evaluation on-going. Device not returned
Patient Sequence No: 1, Text Type: N, H10
[95619546]
(b)(6). During procedure for gynecology, jaw was broken. When cutting a suture, blades crossed. After that, blades opened beyond normal range using for procedure. By x-ray, any metal fragments were not found in the abdominal cavity. No injury for the patient has been currently reported. Components in use listed as concomitant devices are: po602r / jaw ins. Micro-dissector sciss 5mm 310mm, pm973r / nsulated outer tube 5/5mm 310mm, po958r / monopolar handle without ratchet.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9610612-2017-00630 |
| MDR Report Key | 7138921 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2017-12-21 |
| Date of Report | 2018-01-19 |
| Date of Event | 2017-12-18 |
| Date Facility Aware | 2017-12-21 |
| Date Mfgr Received | 2017-12-19 |
| Date Added to Maude | 2017-12-21 |
| 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 | MS. NICOLE BROYLES |
| Manufacturer Street | 615 LAMBERT POINTE DRIVE |
| Manufacturer City | HAZELWOOD MO 63042 |
| Manufacturer Country | US |
| Manufacturer Postal | 63042 |
| Manufacturer Phone | 3145515988 |
| Manufacturer G1 | AESCULAP AG |
| Manufacturer Street | PO BOX 40 |
| Manufacturer City | TUTTLINGEN, 78501 |
| Manufacturer Country | GM |
| Manufacturer Postal Code | 78501 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | JAW INS.MICRO-DISSECTOR SCISS 5MM 310MM |
| Generic Name | ENDOSCOPY |
| Product Code | KNF |
| Date Received | 2017-12-21 |
| Model Number | PO602R |
| Catalog Number | PO602R |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | AESCULAP AG |
| Manufacturer Address | PO BOX 40 TUTTLINGEN, 78501 GM 78501 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2017-12-21 |