FDA Adverse Event Other Summary report: N

VAPORIZATION RESECTOTRODE

MDR report key: 2163647 · Received June 10, 2011

Report

Report Number
3006159227-2011-00004
Event Type
Other
Date Received
June 10, 2011
Date of Event
May 11, 2011
Report Date
June 10, 2011
Manufacturer
GYRUS ACMI, INC.
Product Code
FAS
PMA / PMN Number
K973820
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CA
Reporter Occupation
NOT APPLICABLE

Narratives

Additional Manufacturer Narrative · 1

AT THE TIME OF THIS REPORT, MULTIPLE ATTEMPTS TO OBTAIN FURTHER INFO FROM THE HOSPITAL HAVE BEEN UNSUCCESSFUL, AND THE DEVICE HAS NOT YET BEEN RETURNED FOR EVALUATION. AS A RESULT, A DETERMINATION CANNOT BE MADE AT THIS TIME. IF FURTHER INFO BECOMES AVAILABLE, GYRUS ACMI WILL CONTINUE THE INVESTIGATION AND UPDATE THE AGENCY ACCORDINGLY.

Description of Event or Problem · 1

A TRANSURETHRAL ELECTRO-RESECTION OF THE PROSTATE PROCEDURE WAS BEING PERFORMED WITH THE ROLERBALL VAPORIZATION, USING THE WORKING ELEMENT, RESEC TRODE, AND ACTIVE CORD. INTRO-OPERATIVELY, THE SURGEON EXPERIENCED A SHOCK AND SPARKS WERE SEEN BY THE SURGEON ON THE BACK END OF THE SCOPE. NO BURNS WERE EXPERIENCED BY THE PT OR THE SURGEON. CROSS-REFERENCE MEDWATCH #1519132-2011-00014 AND 1519132-2011-00015.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 VAPORIZATION RESECTOTRODE VAPORIZATION RESECTOTRODE FAS GYRUS ACMI, INC. VE-RT

Patients

Seq Age Sex Outcome Treatment
1