MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2020-02-14 for TRIVEX SYSTEM RESECTOR HANDPIECE 7210387 manufactured by Lemaitre Vascular, Inc..
[185004464]
We have not received the device for evalution. Hence, we could not conclusively determine the root cause of the malfunction at this time. There has been no serious injury ( 21 cfr 803. 3 ) nor would the malfunction result in a death or serious injury if it was to reoccur since the resector could not be used for the procedure. However, we have decided to report the incident since our evaluation was based on the reported defect from the user at the hospital rather than our hands-on evaluation with this defective device itself.
Patient Sequence No: 1, Text Type: N, H10
[185004465]
During pre-use check, the handpiece failed to operate. Device was not used for the procedure.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1220948-2020-00018 |
| MDR Report Key | 9712014 |
| Report Source | COMPANY REPRESENTATIVE,HEALTH |
| Date Received | 2020-02-14 |
| Date of Report | 2020-02-12 |
| Date of Event | 2019-10-17 |
| Date Mfgr Received | 2019-10-17 |
| Date Added to Maude | 2020-02-14 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MR. PRAGYA THIKEY |
| Manufacturer Street | 63 SECOND AVE |
| Manufacturer City | BURLINGTON, MA |
| Manufacturer Country | US |
| Manufacturer Phone | 2212266152 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | TRIVEX SYSTEM RESECTOR HANDPIECE |
| Generic Name | HANDPIECE |
| Product Code | DWQ |
| Date Received | 2020-02-14 |
| Model Number | 7210387 |
| Catalog Number | 7210387 |
| Lot Number | YB02293 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | LEMAITRE VASCULAR, INC. |
| Manufacturer Address | 63 SECOND AVE BURLINGTON, MA US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2020-02-14 |