BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    GREENLIGHT ADDSTAT

    MDR report key: 2093516 · Received April 6, 2011

    Report

    Report Number
    2937094-2011-00546
    Event Type
    Malfunction
    Date Received
    April 6, 2011
    Date of Event
    September 16, 2010
    Report Date
    November 9, 2010
    Manufacturer
    AMS, INNOVATION CTR - SILICON VALLEY
    Product Code
    GEX
    PMA / PMN Number
    K062719
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    THE EVENT DESCRIPTION THE CUSTOMER REPORTED TO AMS DID NOT INDICATE A POTENTIAL PT SAFETY ISSUE. THE DEVICE WAS SUBSEQUENTLY RETURNED TO AMS AND ANALYZED. THE INFO FROM THIS FAILURE ANALYSIS WAS RECEIVED ON (B)(4) 2011 AND THE RESULTS OF THE FAILURE ANALYSIS INDICATED THAT AN MDR WAS REQUIRED. THE FAILURE ANALYSIS DISCLOSED THAT THE FIBER CAP FRACTURED AND PARTIALLY BROKE OFF. THE FIBER HAD A BROKEN OR MELTED BEVEL AREA. PART OF THE FIBER CAP BROKE OFF. BURNT GLUE ON THE BEVEL PORTION OF THE FIBER WAS GENERALLY EVIDENT. THIS DEVICE FAILURE IS ASSOCIATED WITH A LACK OF COOLING. THE ROOT CAUSE OF THE DEVICE FAILURE WAS DETERMINED TO BE TISSUE CONTACT AND EMBEDMENT. THE PRODUCT LABELING (PRODUCT INSERT 0127-1410) WARNS THAT TISSUE CONTACT OR TISSUE PROBING MAY CAUSE FIBER DAMAGE OR BREAKAGE. THE PRODUCT LABELING ALSO WARNS OF POSSIBLE CAP DETACHMENT IN THE PT AND INSTRUCTIONS FOR RETRIEVING.

    Description of Event or Problem · 1

    IT WAS REPORTED BY A CUSTOMER ON (B)(4) 2010 MORE JOULES WERE NEEDED DUE TO A LARGE GLAND SIZE AT 277,036 JOULES. A FAILURE ANALYSIS, CONDUCTED BY AN AMERICAN MEDICAL SYSTEMS QUALITY ENGINEER, DISCLOSED THAT THE FIBER CAP FRACTURED AND PARTIALLY BROKE OFF.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 GREENLIGHT ADDSTAT SURGICAL FIBER GEX AMS, INNOVATION CTR - SILICON VALLEY NA 023H

    Patients

    Seq Age Sex Outcome Treatment
    1 Other