FDA Adverse Event Injury Summary report: N

HZ APPLIER MICRO 6" CVD

MDR report key: 14455587 · Received May 20, 2022

Report

Report Number
3011137372-2022-00082
Event Type
Injury
Date Received
May 20, 2022
Date of Event
December 1, 2021
Report Date
April 25, 2022
Manufacturer
TELEFLEX MEDICAL
Product Code
GDO
UDI-DI
24026704696639
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
FI
Reporter Occupation
PHYSICIAN
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

(B)(4). THE DEVICE INVESTIGATION IS PENDING.

Additional Manufacturer Narrative · 0

(B)(4). THE DHR FOR THE RETURNED INSTRUMENT WAS REVIEWED AND FOUND COMPLETELY WITHOUT ANY IRREGULARITIES. THIS INSTRUMENT WAS PRODUCED AT THE TELEFLEX MEDICAL KENOSHA, WI FACILITY AS PART OF A (B)(4)-PIECE LOT IN SEPTEMBER OF 2010. EVALUATION OF THE RETURNED INSTRUMENT SHOWS THAT THE JAWS ARE ALIGNED WITH EACH OTHER IN THE CLOSED POSITION. FUNCTIONAL TESTING SHOWS THAT THIS INSTRUMENT WAS ABLE TO PICK-UP, RETAIN, CLOSE AND RELEASE MULTIPLE CLIPS WITHOUT ANY ISSUES. WE ARE UNABLE TO REPLICATE THE ALLEGED ISSUE THEREFORE WE ARE UNABLE TO VALIDATE THIS COMPLAINT. ALL 90 INSTRUMENTS FROM THIS LOT WERE 100% VISUALLY INSPECTED AND FUNCTION TESTED PRIOR TO SHIPMENT TO THE CUSTOMER AS THIS IS A STANDARDIZED PROCEDURE AT THIS FACILITY FOR THIS PRODUCT LINE. DUE TO THESE FINDINGS, NO FURTHER ACTIONS WILL BE TAKEN IN RESPONSE TO THIS COMPLAINT AND THIS RECORD WILL BE DEEMED CLOSED.

Description of Event or Problem · 0

WHEN CLOSING VESSEL WITH MICROCLIP VESSEL IS CUT.

Description of Event or Problem · 0

WHEN CLOSING VESSEL WITH MICROCLIP VESSEL IS CUT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2577797 HZ APPLIER MICRO 6" CVD APPLIER, SURGICAL, CLIP GDO TELEFLEX MEDICAL IPN008962 06B1020157 24026704696639

Patients

Seq Age Sex Outcome Treatment
1 Unknown Other