BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MULTIPLE CLIP APPLIER LIGACLIP

    MDR report key: 12852304 · Received November 22, 2021

    Report

    Report Number
    2134070-2021-00026
    Event Type
    Malfunction
    Date Received
    November 22, 2021
    Date of Event
    October 26, 2021
    Report Date
    November 22, 2021
    Manufacturer
    STERILMED, INC.
    Product Code
    NMJ
    UDI-DI
    10888551019071
    PMA / PMN Number
    K033579
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WV, US
    Reporter Occupation
    OTHER
    Health Professional
    N

    Narratives

    Additional Manufacturer Narrative · 0

    IT WAS REPORTED THAT A PATIENT UNDERWENT A BREAST LUMPECTOMY WITH A REPROCESSED MULTIPLE CLIP APPLIER LIGACLIPS AND WHEN CLIP APPLIER FIRED IT DID NOT CLOSE ON TISSUE. THE RETURNED DEVICE WAS RECEIVED INSIDE A SEALED PLASTIC BIOHAZARD BAG, WITH NONE OF THE ORIGINAL PACKAGING OR LABELING RETURNED. THERE ARE NO FIRED CLIPS FROM THIS DEVICE PROVIDED AS WELL. IT WAS OBSERVED THAT THE DEVICE WAS MARKED FOR (B)(6) CLIPS BEING SENT TO THE CUSTOMER. HOWEVER, THE DEVICE HAS BEEN RETURNED WITH THE YELLOW TAB FULLY FORWARD AND THE LOCKING MECHANISM ENGAGED. THERE ARE NO REMAINING CLIPS. ALL (B)(6) CLIPS HAVE BEEN FIRED FROM THIS DEVICE. AS THERE ARE NO REMAINING CLIPS AND THE HANDLE IS LOCKED, THE FIRING CAPABILITY OF THE DEVICE CANNOT BE OBSERVED. THE JAWS OF THE DEVICE APPEAR PROPERLY SPACED AND ALIGNED. THERE ARE NO OBSERVED VISUAL DEFECTS WITH THE DEVICE. THERE WAS NO ADDITIONAL EVIDENCE PROVIDED SHOWING THE CONDITION OF THE FIRED CLIPS FROM THIS DEVICE. AS THERE WAS NO EVIDENCE OF A DEFECT WITH THIS DEVICE, THE REPORTED ISSUE WAS NOT CONFIRMED. AS PRODUCT WAS REMOVED FROM ITS PACKAGING AND WAS USED BY THE ACCOUNT, NO CONCLUSION AS TO THE CAUSE OF THE REPORTED ISSUE IS DETERMINED. THE DEVICE HISTORY RECORD OF LOT 2153586 WAS REVIEWED AND ALL FINISHED GOODS PRODUCTS REPROCESSED UNDER THIS LOT PASSED ALL VISUAL AND FUNCTIONAL CRITERIA PRIOR TO BEING DISTRIBUTED TO THE CUSTOMER. NO FAILURE WAS OBSERVED ON THE DEVICE. IF ADDITIONAL INFORMATION IS RECEIVED REGARDING THIS EVENT, A SUPPLEMENTAL 3500A REPORT WILL BE SUBMITTED TO THE FDA. MANUFACTURER'S REF. NO: (B)(4).

    Additional Manufacturer Narrative · 0

    THE PRODUCT ANALYSIS LAB RECEIVED THE DEVICE FOR EVALUATION. WHEN THE INVESTIGATIONAL ANALYSIS HAS BEEN COMPLETED, A SUPPLEMENTAL 3500A REPORT WILL BE SUBMITTED. IF INFORMATION IS OBTAINED THAT WAS NOT AVAILABLE FOR THE INITIAL REPORT, A FOLLOW-UP REPORT WILL BE FILED AS APPROPRIATE. MANUFACTURE REPORT NUMBERS 2134070-2021-00025 ARE RELATED TO THE SAME EVENT. (B)(4).

    Description of Event or Problem · 0

    IT WAS REPORTED THAT A PATIENT UNDERWENT A BREAST LUMPECTOMY WITH TWO REPROCESSED MULTIPLE CLIP APPLIER LIGACLIPS AND WHEN CLIP APPLIER FIRED IT DID NOT CLOSE ON TISSUE. A NEW NON-REPROCESSED DEVICE WAS USED TO COMPLETE THE PROCEDURE. THE INTENT OF THE PROCEDURE WAS NOT ALTERED BECAUSE OF THIS EVENT. THERE WAS NO PATIENT CONSEQUENCE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1751682 MULTIPLE CLIP APPLIER LIGACLIP CLIP, IMPLANTABLE, REPROCESSED NMJ STERILMED, INC. ETHMCM30 2153586 10888551019071

    Patients

    Seq Age Sex Outcome Treatment
    1 Unknown