FDA Adverse Event Injury Summary report: N

ACTIVE ELECTRICAL CORD

MDR report key: 1329 · Received September 15, 1992

Report

Report Number
1329
Event Type
Injury
Date Received
September 15, 1992
Date of Event
August 26, 1992
Report Date
September 3, 1992
Manufacturer
LINVATEC/WECK
Product Code
FFZ
Adverse Event
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

DURING OR PROCEDURE, EUA, D &C, LASER LAPAROSCOPY AND LYSIS OF ADHESIONS, A MONOPOLAR CAUTERY CORD WAS ACTIVATED BY THE PHYSICIAN, IT THEN SUDDENLY SPLIT AND ARCHED, IGNITING THE DRAPE ON THE PATIENT'S RIGHT THIGH. PATIENT SUSTAINED A 1-1/2 CM. SECOND DEGREE BURN WHICH IS BEING TREATED WITH TOPICAL MEDICATION, AS AN OUTPATIENTDEVICE 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: 01-FEB-92. SERVICE PROVIDED BY: USER FACILITY BIOMEDICAL/BIOENGINEERING DEPARTMENT. SERVICE RECORDS AVAILABLE.NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: ACTUAL DEVICE INVOLVED IN INCIDENT WAS EVALUATED, ELECTRICAL TESTS PERFORMED, MECHANICAL TESTS PERFORMED, VISUAL EXAMINATION. RESULTS OF EVALUATION: MATERIAL DEGRADATION/DETERIORATION, CABLE. CONCLUSION: DEVICE FAILURE DIRECTLY CONTRIBUTED TO EVENT. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: YES. CORRECTIVE ACTIONS: DEVICE PERMANENTLY REMOVED FROM SERVICE. THE DEVICE WAS NOT DESTROYED/DISPOSED OF.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 ACTIVE ELECTRICAL CORD FFZ LINVATEC/WECK

Patients

Seq Age Sex Outcome Treatment
1 39 YR Required Intervention