BEUDAMED
    FDA Adverse Event Injury Summary report: N

    GYNECARE MORCELLEX* TISSUE MORCELLATOR

    MDR report key: 3142731 · Received June 3, 2013

    Report

    Report Number
    2210968-2013-06406
    Event Type
    Injury
    Date Received
    June 3, 2013
    Date of Event
    May 15, 2013
    Report Date
    May 15, 2013
    Manufacturer
    ETHICON, INC.
    Product Code
    HET
    PMA / PMN Number
    K100280
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). CONCLUSION: THE PRODUCT UPON WHICH THIS MEDWATCH IS BASED IS ANTICIPATED. ONCE THE PRODUCT IS RECEIVED, ANY FURTHER INFORMATION DERIVED FROM THE EVALUATION WILL BE SUBMITTED IN A SUPPLEMENTAL 3500A FORM. THIS IS ONE OF THREE MEDWATCHES BEING SUBMITTED AS THREE DEVICES WERE INVOLVED IN THIS EVENT. SEE ALSO MEDWATCH 2210968-2013-06404 AND MEDWATCH 2210968-2013-06405. THE SAME PATIENT IS REPRESENTED IN EACH MEDWATCH.

    Additional Manufacturer Narrative · 1

    CONCLUSION: THE ACTUAL DEVICE INVOLVED IN THIS EVENT WAS RETURNED FOR EVALUATION. THE MAIN HOUSING WAS RECEIVED IN A DISASSEMBLED CONDITION. FUNCTIONAL TESTS INVOLVING THE MAIN HOUSING COULD NOT BE PERFORMED. UPON EVALUATION, THE TRIGGER OPERATED AS INTENDED. IN ADDITION, A REVIEW OF THE BATCH MANUFACTURING RECORDS WAS CONDUCTED AND THE BATCH MET ALL FINISHED GOODS RELEASE CRITERIA.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT A PATIENT UNDERWENT A MYOMECTOMY ON (B)(6) 2013. DURING THE PROCEDURE, THE SURGEON MORCELLATED THE RESIDUAL MYOMA. AFTER TEN TO FIFTEEN MINUTES, THE DEVICE WOULD NOT ACTIVATE. THE SURGEON EXTENDED THE PORT INCISION BY 40MM TO REMOVE THE RESIDUAL MYOMA USING FORCEPS UNDER DIRECT VISION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    244456 GYNECARE MORCELLEX* TISSUE MORCELLATOR LAPAROSCOPE, GYNECOLOGIC HET ETHICON, INC. NA MT217826

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention