FDA Adverse Event Other Summary report: N

SNOWDEN PENCER

MDR report key: 19013372 · Received March 29, 2024

Report

Report Number
MW5153422
Event Type
Other
Date Received
March 29, 2024
Date of Event
March 5, 2024
Report Date
March 27, 2024
Manufacturer
CAREFUSION 2200, INC.
Product Code
GEI
Adverse Event
Yes
Report Source
Voluntary report
Reporter Location
CA, US
Reporter Occupation
UNKNOWN
Health Professional
*

Narratives

Description of Event or Problem · 0

ON BEHALF OF KARL STORZ ENDOSCOPY-AMERICA, INC., I¿M WRITING TO PROVIDE CLARIFICATION ON AN INCIDENT THAT OCCURRED ON (B)(6) 2024, WHICH INVOLVED A MALFUNCTION FROM A HAND INSTRUMENT THAT BURNED THE SURFACE OF A PATIENT¿S SKIN DURING A PROCEDURE (REF.976988). UPON FURTHER INVESTIGATION, OUR TEAM DETERMINED THAT THE PRODUCT IN QUESTION THAT CAUSED AN ADVERSE EVENT WAS NOT MANUFACTURED NOR DESIGNED BY KARL STORZ ENDOSCOPY. THE ALLEGED PRODUCT WAS A SNOWDEN PENCER 89-4000. AS A RESULT, OUR TEAM IS NOT REQUIRED TO SUBMIT AN MDR. HOWEVER, I WOULD LIKE TO ACKNOWLEDGE THAT A KARL STORZ-LAP UROLOGY TRAY (KSZ-27717DS), WAS USED WHEN THE USER FACILITY STERILIZED THE NON-KARL STORZ INSTRUMENT THAT WAS INVOLVED IN THE INCIDENT. THE KARL STORZ TRAY DID NOT CONTRIBUTE TO NOR CAUSE THE MALFUNCTION AND SERIOUS INJURY. WE REMAIN DEDICATED TO PATIENT SAFETY AND REGULATORY COMPLIANCE. PLEASE LET ME KNOW IF THERE IS ANYTHING I CAN DO TO PROVIDE MORE CLARITY ON THIS INCIDENT. THIS REPORT REFLECTS INFORMATION RECEIVED BY FDA IN THE FORM OF A NOTIFICATION PER 803.22 (B)(2).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1567528 SNOWDEN PENCER ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES GEI CAREFUSION 2200, INC. 89-4000

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown