FDA Adverse Event Malfunction Summary report: N

PROFLEX¿

MDR report key: 22122549 · Received June 2, 2025

Report

Report Number
22122549
Event Type
Malfunction
Date Received
June 2, 2025
Date of Event
May 1, 2025
Report Date
May 14, 2025
Manufacturer
INNOVAQUARTZ LLC
Product Code
GEX
Product Problem
Yes
Report Source
User Facility report
Reporter Location
CA
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Description of Event or Problem · 0

WHILE USING THE LASER, SURGEON VERBALIZED THAT THE TIP OF THE LASER BROKE OFF IN THE PATIENT. THE SOUTHLAND LASER REP WAS PRESENT AT THE TIME AND ESCALATED THE SITUATION TO HIS SUPERVISOR. DEVICE WAS SEQUESTERED. THE PIECE OF LASER LEFT IN THE BODY WAS THEN RETRIEVED WITH A STONE BASKET AND VISUALIZED BY SURGEON THAT IT WAS TAKEN OUT OF THE BODY. SURGEON ALSO VERBALIZED THAT THIS ISN'T THE FIRST TIME THIS HAS HAPPENED WHERE THE TIP WAS FAULTY. [REDACTED] THE REP WAS INSTRUCTED BY THE SURGEON TO INVESTIGATE ON THE COMPANY'S END THE CAUSE. PER BIOMEDICAL ENGINEER EVALUATION: THE LASER FIBER TIP BROKE OFF, WAS DUE TO A FAULTY DISPOSABLE ITEM. THE FAULT WAS NOT THE LASER, BUT THE DISPOSABLE USED. THE LASER TECHNICIAN AND DISPOSABLE REP WERE PRESENT, AND THEY WERE AWARE OF THE LASER FIBER BEING FAULTY. THE MANUFACTURER IS AWARE (REP KNEW OF THE INCIDENT). THIS EVENT IS NOT THE LASER ITSELF. MANUFACTURER RESPONSE FOR LITHOTRIPSY FIBER, PROFLEX 273 LASER LITHOTRIPSY FIBER VAR. TRIMEDYNE (PER SITE REPORTER). UNDER INVESTIGATION.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
578776 PROFLEX¿ POWERED LASER SURGICAL INSTRUMENT GEX INNOVAQUARTZ LLC SINGLE USE 273 LASER LITHOTRIPSY FIBER VAR. TRIMEDYNE 24024001

Patients

Seq Age Sex Outcome Treatment
1 61 YR Female