ACCURE LASER SYSTEM
Report
- Report Number
- 3017786046-2023-00002
- Event Type
- Injury
- Date Received
- September 13, 2023
- Date of Event
- July 13, 2023
- Report Date
- September 13, 2023
- Manufacturer
- ACCURE ACNE, INC.
- Product Code
- GEX
- PMA / PMN Number
- K222109
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- TX, US
- Reporter Occupation
- 117
Narratives
A SERVICE TECHNICIAN VISITED THE SITE AND FOUND ONE OF FOUR TREATMENT LOCATIONS WAS DELIVERING HIGHER THAN EXPECTED POWER. THE REGION OF INTEREST (ROI) #4 WAS OUT OF POSITION AND HAD TO BE CORRECTED. ROI MISALIGNMENT WAS CAUSED BY EXCESSIVE HANDPIECE TIP MOVEMENT BY THE USER. FOLLOW-UP INFORMATION INDICATED THE PROVIDER DID NOT USE ALCOHOL AS THE FINAL STEP IN REMOVAL OF THE TOPICAL ANESTHETIC. IN ADDITION, PURACYN PLUS ANTIMICROBIAL SOLUTION WAS APPLIED PRIOR TO LASER ENERGY APPLICATION. THE ROI MISALIGNMENT CREATED A HIGHER-THAN-EXPECTED POWER RESULTING IN THE BLISTERING. THE ADDITION OF PURACYN PLUS AND POSSIBLE INCOMPLETE REMOVAL OF THE TOPICAL ANESTHETIC CAN BE A CONTRIBUTING FACTOR TO LOCALIZED THERMAL ABSORPTION OF ENERGY.
ACCURE WAS NOTIFIED BY A PROVIDER THAT A PATIENT EXHIBITED BLISTERING AFTER TREATMENT. AT THE FOLLOW UP VISIT, ABOUT THREE WEEKS LATER, THE PATIENT PRESENTED WITH SCARRING. THE PROVIDER TREATED THE PATIENT WITH TWO DIFFERENT LASER TREATMENTS SPECIFICALLY TO RESOLVE POST INFLAMMATORY ERYTHEMA AND SCARRING.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 84272 | ACCURE LASER SYSTEM | ACNE LASER | GEX | ACCURE ACNE, INC. | PFMS00004 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 25 YR | Female | Required Intervention |