BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    N/A

    MDR report key: 1741173 · Received June 29, 2010

    Report

    Report Number
    2090040-2010-00002
    Event Type
    Malfunction
    Date Received
    June 29, 2010
    Date of Event
    May 27, 2010
    Report Date
    June 29, 2010
    Manufacturer
    ASCENT HEALTHCARE SOLUTIONS
    Product Code
    NKX
    PMA / PMN Number
    K050518
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IS
    Reporter Occupation
    BIOMEDICAL ENGINEER

    Narratives

    Additional Manufacturer Narrative · 1

    THE PHACO TIP WAS VISUALLY INSPECTED AND FOUND TO HAVE BROKEN ACROSS THE ABS PORT OF THE PHACO TIP. THE MOST PROBABLE CAUSE OF THE DEVICE FAILURE IS DUE TO FATIGUE. THE FATIGUE IS MOST LIKELY FROM THE ULTRASONIC ENERGY AND CAUSED A CRACK TO FORM. THE DEVICE HISTORY RECORD FOR THE RETURNED DEVICE INDICATES THAT THE DEVICE PASSED ALL APPLICABLE INSPECTIONS AND TESTS PRIOR TO RELEASE.

    Description of Event or Problem · 1

    DURING THE PROCEDURE THE TIP OF THE PHACO BROKE OFF. THE TIP WAS RETRIEVED AND NO PATIENT INJURY WAS REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 N/A NKX NKX ASCENT HEALTHCARE SOLUTIONS 8065750263 837116SH

    Patients

    Seq Age Sex Outcome Treatment
    1