MAUDE MDR 7751847

MDR report key
7751847
Report number
1320894-2018-00180
Event key
0
Event type
3
Date of event
2018-07-12
Date received
2018-08-06
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
3
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MR. JOHN BERGA
Address
11311 CONCEPT BLVD. LARGO FL 33773 US
Phone
727-727-7273
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1REFLEX ELC,20M/L CLIPS,10/11MMAPPLIER, HEMOSTATIC CLIPCONMED CORPORATIONHBT530.R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12018-08-060

Event Narratives#

N

Patient 1

THE BROKEN 530 IS NOT EXPECTED TO BE RETURNED FOR EVALUATION AND REVIEW. PHOTOGRAPHIC EVIDENCE WAS PROVIDED BUT THE REPORTED FAILURE COULD NOT BE VERIFIED. THIS COMPLAINT OF BROKEN DEVICE IS UNABLE TO BE VERIFIED AND A ROOT CAUSE CANNOT BE DETERMINED. A TWO-YEAR REVIEW OF COMPLAINT HISTORY REVEALED THERE HAS BEEN A TOTAL OF 1 COMPLAINTS, REGARDING 1 DEVICES, FOR THIS DEVICE FAMILY AND FAILURE MODE. DURING THIS SAME TIME FRAME (B)(4) DEVICES HAVE BEEN MANUFACTURED AND SHIPPED WORLDWIDE. SHOULD ALL THE COMPLAINT DEVICES HAVE BEEN FOUND CONFIRMED FOR THIS REPORTED FAILURE, THE RATE OF FAILURE WOULD BE (B)(4). IT IS STANDARD MEDICAL PRACTICE TO INSPECT MEDICAL EQUIPMENT PRIOR TO USE.

D

Patient 1

THE SALES REPRESENTATIVE REPORTED ON BEHALF OF THE CUSTOMER THAT THE 530., REFLEX ELC, 20M/L CLIPS, 10/11MM, DEVICE MADE AN AUDIBLE SOUND WHILE BEING USED BY THE SURGEON DURING A PROCEDURE ON (B)(6) 2018. THE CASING TO THE DEVICE SPLIT OPEN AND THEN A SMALL PIECE OF PLASTIC WAS SEEN BY THE TEAM ON THE PATIENT'S LIVER. THE SURGEON REMOVED THE PLASTIC PIECE FROM THE PATIENT. THIS EVENT CAUSED A 10-MINUTE DELAY IN THE PROCEDURE. THE PROCEDURE WAS COMPLETED AS NORMAL USING AN ALTERNATE DEVICE. THERE WAS NO MEDICAL INTERVENTION OR EXTENDED HOSPITAL STAY FOR THE PATIENT DUE TO THIS EVENT. THERE WAS NO REPORT OF INJURY TO THE USER OR THE PATIENT FOR THIS EVENT. THIS REPORT IS BEING RAISED ON THE BASIS OF MALFUNCTION WITH POTENTIAL FOR INJURY UPON REOCCURRENCE.