MAUDE MDR 8121413

MDR report key
8121413
Report number
1221934-2018-55486
Event key
0
Event type
3
Date of event
2018-07-31
Date received
2018-11-30
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
KARA DITTY-BOVARD
Address
325 PARAMOUNT DRIVE RAYNHAM MA 02767 US
Phone
610-610-6103
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1TCK1 HD CAMERA HEADENDOSCOPIC VIDEO CAMERAMEDOS INTERNATIONAL SàRLFWF242400Y R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12018-11-300

Event Narratives#

N

Patient 1

IF ADDITIONAL INFORMATION SHOULD BECOME AVAILABLE, A SUPPLEMENTAL MEDWATCH WILL BE SUBMITTED ACCORDINGLY. UDI: (B)(4). AS OF THIS DATE, THE DEVICE HAS NOT BEEN RETURNED FOR EVALUATION; THEREFORE, THE REPORTED CONDITION CANNOT BE CONFIRMED AND/OR DUPLICATED. IF INFORMATION IS OBTAINED THAT WAS NOT AVAILABLE FOR THE INITIAL MEDWATCH, A FOLLOW-UP MEDWATCH WILL BE FILED AS APPROPRIATE.

D

Patient 1

IT WAS REPORTED BY THE AFFILIATE IN (B)(6) THAT PRE-SURGERY TO AN UNSPECIFIED SURGICAL PROCEDURE, IT WAS OBSERVED THAT THE CAMERA HEAD DEVICE WAS NOT GETTING DETECTED ON SWITCHING ON THE CCU AND MONITOR. IT WAS NOT REPORTED IF THERE WAS A DELAY IN THE SURGICAL PROCEDURE. IT WAS REPORTED THAT A SPARE DEVICE WAS AVAILABLE FOR USE. IT WAS REPORTED IF THE PROCEDURE WAS COMPLETED. IT WAS NOT REPORTED IF THERE WAS A DELAY IN THE SURGICAL PROCEDURE OR IF A SPARE DEVICE WAS AVAILABLE FOR USE. THERE WAS NO PATIENT INVOLVEMENT. THERE WERE NO REPORTS OF INJURIES, MEDICAL INTERVENTION OR PROLONGED HOSPITALIZATION. THE EXACT DATE OF THIS EVENT WAS UNKNOWN BUT WAS NOTED TO HAVE OCCURRED IN 2018. ALL AVAILABLE INFORMATION HAS BEEN DISCLOSED. IF ADDITIONAL INFORMATION SHOULD BECOME AVAILABLE, A SUPPLEMENTAL MEDWATCH REPORT WILL BE SUBMITTED ACCORDINGLY.

N

Patient 1

IF INFORMATION IS OBTAINED THAT WAS NOT AVAILABLE FOR THE INITIAL MEDWATCH, A FOLLOW-UP MEDWATCH WILL BE FILED AS APPROPRIATE. EVALUATION STATEMENT: THE DEVICE WAS RECEIVED AT SERVICE CENTER AND EVALUATED. THE COMPLAINT IS CONFIRMED. AS PER THE SERVICE REPORT IT IS CHECKED AND FOUND THE CAMERA HEAD IS NOT SENSED BY CCU AND COMPLAINT DEVICE IS NOT REPAIRABLE. THE ROOT CAUSE FOR THE REPORTED PROBLEM IS UNDETERMINED. NO NONCONFORMANCES WERE IDENTIFIED FOR THIS PART NUMBER 242400, SERIAL NUMBER (B)(4) COMBINATION. AT THIS POINT, NO CORRECTIVE ACTION IS REQUIRED AND NO FURTHER ACTION IS WARRANTED. HOWEVER, DEPUY SYNTHES MITEK WILL CONTINUE TO TRACK ANY RELATED COMPLAINTS WITHIN THIS DEVICE FAMILY AS A MEANS OF MONITORING THE EXTENT WITH WHICH THIS COMPLAINT IS OBSERVED IN THE FIELD. (B)(4). CORRECTED DATA: DATE DEVICE RETURNED TO MANUFACTURER.

D

Patient 1

ADDITIONAL INFORMATION RECEIVED FROM AFFILIATE ON 18NOVEMBER2018: THE ISSUES WAS DETECTED PRE-OPERATIVELY ON (B)(6) 2018. THERE WAS NO PROCEDURE OR PATIENT IMPACT.