FDA Adverse Event Malfunction Summary report: N

SAME

MDR report key: 1076 · Received July 4, 1992

Report

Report Number
1076
Event Type
Malfunction
Date Received
July 4, 1992
Date of Event
June 2, 1992
Manufacturer
SITE MICROSURGICAL SYSTEMS, INC.
Product Code
KBO
Product Problem
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

IT WAS REPORTED TO ME THAT A VITRIOUS LEAK OCCURRED DURING SURGERY. THE SITE-UNIT WAS IN USE AND THE GUILLOTINE TIP WAS SET UP BUT WOULD NOT TURN SUFFICIENTLY. REP WAS PRESENT, AND WHETHER THE TIP OR THE FOOTPEDAL WAS A PROBLEM WAS NOT DETERMINED. SUBSEQUENT INSPECTION AND TESTING AFTER THE CASE DEMONSTRATED NO PROBLEM WITH EITHER. TIP SENT TO IOLAB FOR EVALUATION. THE HANDPIECE WAS NOT FOUND TO BE PROBLEMATIC. INSPECTION BY ANOTHER REP, BEFORE THE TIP WAS SENT OUT ALSO INDICATED THAT THE TIP WORKED BUT OPERATION COULD BE SMOOTHER. AFTER REVIEW, IOLAB SUGGESTED REPAIR OR DREPLACEMENT. PATIENT REQUIRED SECOND SURGERYDEVICE NOT LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: SATISFACTORY CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.DEVICE SERVICED IN ACCORDANCE WITH SERVICE SCHEDULE. DATE LAST SERVICED: . SERVICE PROVIDED BY: DISTRIBUTOR. SERVICE RECORDS NOT AVAILABLE.NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: PERFORMANCE TESTS PERFORMED, VISUAL EXAMINATION. RESULTS OF EVALUATION: COMPONENT FAILURE. CONCLUSION: INTERMITTENT FAILURE DIRECTLY CONTRIBUTED TO EVENT. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: MAYBE. CORRECTIVE ACTIONS: DEVICE DISCARDED. THE DEVICE WAS NOT DESTROYED/DISPOSED OF.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 SAME GUILLOTINE TIP KBO SITE MICROSURGICAL SYSTEMS, INC. N/A N/A

Patients

Seq Age Sex Outcome Treatment
1 75 YR Other