BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    HARMONIC ACE 36 CM

    MDR report key: 1182851 · Received October 3, 2008

    Report

    Report Number
    1527736-2008-03754
    Event Type
    Malfunction
    Date Received
    October 3, 2008
    Date of Event
    May 19, 2008
    Report Date
    June 2, 2008
    Manufacturer
    ETHICON ENDO SURGERY, INC. (CINCINNATI)
    Product Code
    LFL
    PMA / PMN Number
    K042777
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WV, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    DATE SENT: 06/16/2008. INFO ANTICIPATED, BUT UNAVAILABLE AT THIS TIME. SBW4/NXG4 09/03/2008.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE DEVICE WAS USED DURING ADRENALECTOMY. THE WHITE PAD FELL OFF INTO THE PT, THE PAD WAS RETRIEVED WITH NO CONSEQUENCE TO THE PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HARMONIC ACE 36 CM NONE LFL ETHICON ENDO SURGERY, INC. (CINCINNATI) NA E4KM44

    Patients

    Seq Age Sex Outcome Treatment
    1 HANDPIECE| GENERATOR