MAUDE MDR 9366

MDR report key
9366
Report number
9366
Event key
0
Event type
3
Date of event
1993-05-05
Date received
1993-08-11
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
0
Initial report to FDA
0
Event location
3

Manufacturer Contact#

Report source
U
Manufacturer link flag
N

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1ELECTROSURGICAL COAG/SUCTION TUBEWECK & COMPANYKCB809600**

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
11993-08-1101. R

Event Narratives#

D

Patient 1

ON 5/5/93, DURING A TONSIL AND ADENOID OPERATION ON A 5 YEAR OLD FEMALE PATIENT, THE SURGEON NOTED A TINY BURN ON THE RIGHT CORNER OF THE LIP AFTER AN ELECTROSURGICAL UNIT. THE ACTURAL COAG/TUBE WAS TESTED BY THE MANUFACTURER AND FOUND TO BE WITHIN SPECIFICATIONS.INVALID DATA - REGARDING SINGLE USE LABELING OF DEVICE. PATIENT MEDICAL STATUS PRIOR TO EVENT: INVALID DATA. INVALID DATA - REGARDING MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY.INVALID DATA - REGARDING WHETHER EVENT PRESENTS IMMINENT HAZARD. INVALID DATA - WHETHER DEVICE USED AS LABELED/INTENDED.INVALID DATA - REGARDING EVALUATION BY USER AFTER EVENT. METHOD OF EVALUATION: INVALID DATA. RESULTS OF EVALUATION: INVALID DATA. CONCLUSION: INVALID DATA. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: INVALID DATA. CORRECTIVE ACTIONS: NO DATA. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.