BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ULTRACISION HARMONIC SCALPEL HAND PIECE

    MDR report key: 1782101 · Received February 12, 2008

    Report

    Report Number
    1527736-2008-00845
    Event Type
    Malfunction
    Date Received
    February 12, 2008
    Date of Event
    January 4, 2008
    Report Date
    January 8, 2008
    Manufacturer
    ETHICON ENDO-SURGERY, INC (CINCINNATI) CINCINNATI OH
    Product Code
    LFL
    PMA / PMN Number
    K002906
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WY, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). EVALUATION SUMMARY: THE HAND PIECE WAS RETURNED WITH A LOOSE MOUNT. IT WAS TESTED ON A GENERATOR AND GAVE AN ERROR CODE 3. THE HAND PIECE WAS DISASSEMBLED; A TORN ACOUSTIC ISOLATOR AND EVIDENCE OF MOISTURE INGRESS WERE FOUND IN THE INSTRUMENT. COMPLAINT INFORMATION IS TRENDED ON A REGULAR BASIS TO DETERMINE IF FURTHER INVESTIGATION IS WARRANTED. THE BATCH HISTORY RECORDS WERE REVIEWED AND NO ANOMALIES WERE NOTED DURING THE MANUFACTURING PROCESS.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT DURING A TONSILLECTOMY, THE DEVICE MADE A LOUD NOISE AND THE SHEATH BECAME HOT. USED ELECTROCAUTERY TO COMPLETE THE CASE WITH NO PATIENT CONSEQUENCE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ULTRACISION HARMONIC SCALPEL HAND PIECE LFL LFL ETHICON ENDO-SURGERY, INC (CINCINNATI) CINCINNATI OH NA NA

    Patients

    Seq Age Sex Outcome Treatment
    1 GENERATOR