MAUDE MDR 9249816

MDR report key
9249816
Report number
3008769756-2019-00047
Event key
0
Event type
3
Date of event
2019-09-27
Date received
2019-10-29
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
MS. KARA DITTY-BOVARD
Address
3529 ANDERSON ST MADISON 53704 US
Phone
610-610-6107
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1NEUWAVE PR XT PROBE 15CM 15GASYSTEM, ABLATION, MICROWAVE AND ACCESSORIESNEUWAVE MEDICAL, INC.NEYPR15XTML19024082R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12019-10-2901. R

Event Narratives#

N

Patient 1

(B)(4). THE LOT WAS NOT PROVIDED; THEREFORE, A MANUFACTURING RECORD EVALUATION COULD NOT BE PERFORMED. ADDITIONAL INFORMATION WAS REQUESTED AND THE FOLLOWING WAS OBTAINED: WHAT WERE THE INDICATIONS FOR THE ABLATION PROCEDURE?- SOFT TISSUE ABLATION. WHAT WAS THE SIZE OF THE LESION?- UNKNOWN. AT WHAT DEPTH WAS THE PROBE TIP LOCATED?- UNKNOWN. WHERE WAS THE TIP OF THE TROCAR IN RELATION TO THE PROBE TIP?- UNKNOWN. WERE ANY ERROR MESSAGES DISPLAYED OR DEVICE ISSUES IDENTIFIED? PLEASE DESCRIBE.- THE TISSUE-LOC THERMOCOUPLE ON CHANNELS 1 AND 3 HAS FAILED. WHEN WAS THE BURN IDENTIFIED? AFTER THE PROCEDURE. WHAT WAS THE DEGREE OF THE SKIN BURN? UNKNOWN. DID THE PATIENT RECEIVE TREATMENT FOR THE SKIN BURN? IF YES, PLEASE DESCRIBE. YES- DEBRIDING. ARE PHOTOS OF THE BURN OR ANY IMAGING AVAILABLE? NO. WHAT IS THE CURRENT STATUS OF THE PATIENT? UNKNOWN.

D

Patient 1

IT WAS REPORTED THAT DURING A LIVER ABLATION: "I WAS NOT PRESENT FOR THE EVENT, BUT WAS RELAYED THE FOLLOWING INFORMATION. A PATIENT SUSTAINED INJURY DURING A MICROWAVE ABLATION PROCEDURE. PATIENT SUSTAINED BURN ON UMBILICUS. THE PROBE USED WAS A PR15XT AND WAS UTILIZED IN CONJUNCTION WITH A METAL TROCAR." IT IS UNKNOWN HOW THE CASE WAS COMPLETED.