FDA Adverse Event Malfunction Summary report: N

KARL STORZ

MDR report key: 3059 · Received July 31, 1992

Report

Report Number
3059
Event Type
Malfunction
Date Received
July 31, 1992
Date of Event
February 20, 1992
Report Date
March 5, 1992
Manufacturer
KARL STORZ
Product Code
JYA
Product Problem
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

DURING CYSTOSCOPY AND URETERAL MEATOTOMY ONE BLADE OF SCISSOR BROKE AWAY. THE SCISSORS WERE REMOVED. A GUIDE WIRE WAS INTRODUCED AND PLACED NEAR THE RENAL STONE. FLUOROSCOPY WAS UTILIZED FOR PLACEMENT OF WIRE AND VISUALIZATION OF BLADDER AND SURROUNDING STRUCTURES, NO FOREIGN BODY/MATERIAL WAS NOTEDDEVICE NOT LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: SATISFACTORY CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY. NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: ACTUAL DEVICE INVOLVED IN INCIDENT WAS EVALUATED, VISUAL EXAMINATION. RESULTS OF EVALUATION: END OF LIFE - EXPECTED, EXPECTED WEAR/DETERIORATION. CONCLUSION: DEVICE DISCARDED - UNABLE TO FOLLOW-UP, DEVICE UNAVAILABLE FOR FOLLOW-UP INVESTIGATION EXAMINATION. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: YES. CORRECTIVE ACTIONS: DEVICE DISCARDED, DEVICE PERMANENTLY REMOVED FROM SERVICE. THE DEVICE WAS DESTROYED/DISPOSED OF.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 KARL STORZ SCISSOR, 7 FRENCH JYA KARL STORZ 27178A N/A

Patients

Seq Age Sex Outcome Treatment
1 46 YR Other