MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2018-05-17 for RADIAL JAW? 4 M00515031 1503 manufactured by Boston Scientific - Costa Rica (coyol).
[108483126]
The complainant was unable to report the lot number; therefore, the manufacture date and the expiration date are unknown. However, the complainant reported that the device was not expired. Although the suspect device has been received, the evaluation has not been completed. Therefore, the cause of the reported malfunction has not been determined. Upon completion of the failure analysis of the complaint device, if there is any further relevant information from that review, a supplemental mdr will be filed.
Patient Sequence No: 1, Text Type: N, H10
[108483127]
It was reported to boston scientific corporation that a radial jaw 4 hot biopsy forceps was used in a biopsy procedure performed on (b)(6) 2018. According to the complainant, during the end of the procedure, when attempting to remove one more polyp, the anesthesiologist felt an electrical shock and a hair singed offed one finger. The anesthesiologist wasn? T wearing gloves when the shock occurred. Furthermore, he wasn't touching the patient but was touching the stretcher. The patient's condition at the conclusion of the procedure was reported to be fine.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3005099803-2018-01583 |
| MDR Report Key | 7521170 |
| Report Source | COMPANY REPRESENTATIVE,HEALTH |
| Date Received | 2018-05-17 |
| Date of Report | 2018-04-19 |
| Date of Event | 2018-04-19 |
| Date Mfgr Received | 2018-06-13 |
| Date Added to Maude | 2018-05-17 |
| 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 | EMP. NANCY CUTINO |
| Manufacturer Street | 100 BOSTON SCIENTIFIC WAY |
| Manufacturer City | MARLBOROUGH MA 01752 |
| Manufacturer Country | US |
| Manufacturer Postal | 01752 |
| Manufacturer Phone | 5086834000 |
| Manufacturer G1 | BOSTON SCIENTIFIC - COSTA RICA (COYOL) |
| Manufacturer Street | 2546 FIRST STREET PROPARK FREE ZONE |
| Manufacturer City | ALAJUELA |
| Manufacturer Country | CS |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | RADIAL JAW? 4 |
| Generic Name | FORCEPS, BIOPSY, ELECTRIC |
| Product Code | KGE |
| Date Received | 2018-05-17 |
| Returned To Mfg | 2018-05-08 |
| Model Number | M00515031 |
| Catalog Number | 1503 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BOSTON SCIENTIFIC - COSTA RICA (COYOL) |
| Manufacturer Address | 2546 FIRST STREET PROPARK FREE ZONE ALAJUELA CS |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2018-05-17 |