BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    4K LAPAROSCOPE, 30 DEG, 10 X 330MM

    MDR report key: 19499091 · Received June 10, 2024

    Report

    Report Number
    1220246-2024-05407
    Event Type
    Malfunction
    Date Received
    June 10, 2024
    Date of Event
    September 24, 2021
    Report Date
    June 10, 2024
    Manufacturer
    ARTHREX, INC.
    Product Code
    GCJ
    UDI-DI
    00888867029729
    PMA / PMN Number
    K941541
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    501

    Narratives

    Additional Manufacturer Narrative · 0

    THIS 3500A RECORD IS SUBMITTED TO COMPLY WITH AN FDA 483 INSPECTIONAL OBSERVATION ISSUED TO ARTHREX INC ON MAY 5, 2023. ARTHREX HAS REASSESSED THE REPORTABILITY DECISIONS MADE ON HISTORICAL COMPLAINT RECORDS USING REVISED CRITERION. THIS 3500A DOCUMENT IS A RESULT OF THE REASSESSMENT. THE COMPLAINT DEVICE WAS NOT RECEIVED FOR EVALUATION. BASED OFF THE INFORMATION PROVIDED, THE MOST LIKELY CAUSE FOR THE REPORTED FAILURE CAN BE ATTRIBUTED TO MISUSE/MISHANDLING OF THE DEVICE.

    Description of Event or Problem · 0

    IT WAS REPORTED THAT THE FRONT OF THE OPTIC IS TOO SHARP. NO ADDITIONAL INFORMATION REGARDING A SPECIFIC FAILURE MODE WAS PROVIDED. NO FURTHER INFORMATION RECEIVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    173292 4K LAPAROSCOPE, 30 DEG, 10 X 330MM LAPAROSCOPE GCJ ARTHREX, INC. 4K LAPAROSCOPE, 30 DEG, 10 X 330MM 00888867029729

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Unknown