FDA Adverse Event Injury Summary report: N

PENTAX PRECISION INSTRUMENT CORPORATION

MDR report key: 149084 · Received February 12, 1998

Report

Report Number
2518897-1998-00001
Event Type
Injury
Date Received
February 12, 1998
Date of Event
February 2, 1998
Report Date
February 11, 1998
Manufacturer
GIP MEDIZIN TECHNIK GMBH
Product Code
LQC
Report Source
Distributor report
Reporter Location
IA, US
Reporter Occupation
NURSE

Narratives

Description of Event or Problem · 1

DEVICE WAS BRAND NEW, USED FOR THE FIRST TIME. IN COMPLIANCE WITH MDR REGULATIONS, PPIC IS HEREBY SUBMITTING THIS INFO CONCERNING AN "EVENT" WHICH HAS OCCURRED DURING AN ENDOSCOPIC PROCEDURE INVOLVING PRODUCT(S) SOLD UNDER PENTAX PRECISION INSTRUMENT CORP BRAND NAME, MFG BY GIP IN GERMANY. AT THE PRESENT TIME DIST HAS NOT REC'D ANY WRITTEN REPORT CONCERNING THIS EVENT. ALL DETAILS WHICH FOLLOW ARE BASED UPON A CONVERSATION WITH INITIAL REPORTER. DURING AN ERCP PROCEDURE A STONE WAS FOUND IN A PT'S COMMON BILE DUCT. AFTER THE STONE WAS "CAPTURED" WITHIN THE BASKET AND THE LITHOTRIPTOR HANDLE WAS "CRANKED" IN AN ATTEMPT TO CRUSH THE STONE, THE LITHOTRIPTOR WIRE SNAPPED. WHEN THE METAL SPIRAL WAS WITHDRAWN FROM THE DUODENOSCOPE, A TWELVE TO EIGHTEEN INCH LENGTH OF FRAYED WIRES WAS LEFT PROTRUDING FROM THE ENDOSCOPE'S CHANNEL INLET. THE WIRE HAD SNAPPED AND WAS COMPLETELY SEVERED AT APPROX 73 INCHES FROM THE DISTAL END. SUBSEQUENTLY, AN ATTEMPT WAS MADE TO FREE THE STONE FROM THE BASKET. HOWEVER, WHEN THIS WAS UNSUCCESSFUL THE PT HAD TO HAVE OPEN SURGERY TO REMOVE THE WIRE/BASKET AS WELL AS SEVERAL STONES RETAINED IN THE GALL BLADDER. ACCORDING TO THE CUSTOMER, THIS WAS THE FIRST TIME THIS LITHOTRIPTOR BASKET WAS USED. THIS INFO IS PRELIMINARY AND ANY OTHER DETAILS AS WELL AS PRODUCT SAMPLES WILL BE SENT TO FDA'S ATTENTION AFTER RECEIPT. A COPY OF THIS EVENT WILL ALSO BE SENT TO MEDIGLOBE IN TEMPE, AZ.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 PENTAX PRECISION INSTRUMENT CORPORATION MECHANICAL LITHOTRIPTOR LQC GIP MEDIZIN TECHNIK GMBH 603630 96111871

Patients

Seq Age Sex Outcome Treatment
1 UNKNOWN Life Threatening| R LITHOTRIPTOR HANDLE CAT. # 82271| LITHOTRIPTOR METAL SPIRAL CAT. # 82272