SURGICAL SPRING CLIPS-DOUBLE SOFT, 6MM G-6000 100374701

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 06,08 report with the FDA on 2007-05-16 for SURGICAL SPRING CLIPS-DOUBLE SOFT, 6MM G-6000 100374701 manufactured by Applied Medical Resources.

Event Text Entries

[20920595] "dr. Applied the vascular clamp into the left internal mammary artery, when it broke into pieces. He needed to explore the chest cavity to look for the broken pieces. "
Patient Sequence No: 1, Text Type: D, B5


[21195478] Evaluation: pieces from four or five different spring clip units were returned and visually inspected. The body female component, is the only broken component returned. Each of the returned body female components split in a different way; but most are split below where the body female snap fits with the female jaw. Conclusion/corrective action: the cause of the incident was investigated but cannot be determined without additional information. The type of clip applicator used, the amount of force applied and other factors are needed to understand the condition the clip was in. Also, since these are non-sterilized clips, the method of sterilization is unknown. Engineering was unable to duplicate the reported incident with the same model clips subjected to 1 gamma radiation sterilization cycle of 25-40kgy using a fully actuated model a3218 clip applicator.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number2027111-2007-00027
MDR Report Key851165
Report Source06,08
Date Received2007-05-16
Date of Event2007-02-19
Date Facility Aware2007-04-09
Date Reported to Mfgr2007-04-09
Date Added to Maude2007-07-05
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA0
Event Location3
Manufacturer ContactSUSAN NICKERSON
Manufacturer Street22872 AVENIDA EMPRESA
Manufacturer CityRANCHO SANTA MARGARITA CA 92688
Manufacturer CountryUS
Manufacturer Postal92688
Manufacturer Phone9497138396
Manufacturer G1APPLIED MEDICAL RESOURCES CORP.
Manufacturer Street22872 AVENIDA EMPRESA
Manufacturer CityRANCHO SANTA MARGARITA CA 92688
Manufacturer CountryUS
Manufacturer Postal Code92688
Single Use3
Remedial ActionRL
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameSURGICAL SPRING CLIPS-DOUBLE SOFT, 6MM
Generic NameSURGICAL SPRING CLIPS
Product CodeDSS
Date Received2007-05-16
Returned To Mfg2007-04-30
Model NumberG-6000
Catalog Number100374701
Lot NumberUNKNOWN
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
Device AgeNA
Device Eval'ed by MfgrY
Implant FlagN
Date RemovedB
Device Sequence No1
Device Event Key838243
ManufacturerAPPLIED MEDICAL RESOURCES
Manufacturer AddressRANCHO SANTA MARGARITA CA US


Patients

Patient NumberTreatmentOutcomeDate
101. Hospitalization; 2. Other 2007-05-16

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