BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PROLIEVE THERMODILITATION KIT

    MDR report key: 1202217 · Received October 16, 2008

    Report

    Report Number
    3005099803-2008-05294
    Event Type
    Malfunction
    Date Received
    October 16, 2008
    Date of Event
    August 29, 2008
    Report Date
    September 19, 2008
    Manufacturer
    BOSTON SCIENTIFIC CORPORATION
    Product Code
    MEQ
    PMA / PMN Number
    P030006
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MA, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    THE DEVICE HAS NOT BEEN RETURNED; THEREFORE, A FAILURE ANALYSIS IS NOT AVAILABLE AND WE ARE NOT ABLE TO DETERMINE THE RELATIONSHIP BETWEEN THIS DEVICE AND THE CAUSE FOR THIS EVENT.

    Description of Event or Problem · 1

    ON SEPTEMBER 19, 2008, IT WAS REPORTED TO BOSTON SCIENTIFIC THAT A PROLIEVE THERMODILITATION KIT WAS USED DURING A BENIGN PROSTATIC HYPERPLASIA (BPH) PROCEDURE THE PREVIOUS MONTH. ACCORDING TO THE COMPLAINANT, DURING THE PROCEDURE, THE PROLIEVE SYSTEM DISPLAYED A "LOW WATER" LEVEL WARNING. THE USER ATTEMPTED TO REFILL THE PROLIEVE CARTRIDGE; HOWEVER, THIS DID NOT RESOLVE THE ISSUE. NO PT COMPLICATIONS WERE REPORTED AS A RESULT OF THIS EVENT. THE PT'S CONDITION WAS REPORTED AS "FINE".

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PROLIEVE THERMODILITATION KIT MEQ BOSTON SCIENTIFIC CORPORATION M0068808022 0000607189

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK