BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LIGAMAX-5MM ENDO CLIP APPLIER

    MDR report key: 3182270 · Received June 21, 2013

    Report

    Report Number
    3005075853-2013-03192
    Event Type
    Malfunction
    Date Received
    June 21, 2013
    Date of Event
    June 5, 2013
    Report Date
    June 5, 2013
    Manufacturer
    ETHICON ENDO-SURGERY, LLC.
    Product Code
    FZP
    PMA / PMN Number
    K050344
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). INFORMATION WAS NOT PROVIDED BY THE INITIAL CONTACT. INFORMATION ANTICIPATED, BUT UNAVAILABLE AT THIS TIME. ADDITIONAL INFORMATION: DO YOU KNOW WHAT THE ACCOUNT MEANT WHEN THEY STATED THAT THE DEVICE MISFIRED? THEY TOLD ME THE CLIP WAS SCISSORED, NOT FORMED PROPERLY. WAS THERE ANY PATIENT CONSEQUENCE? IF SO PLEASE EXPLAIN. NO. DUE TO THE ADDITIONAL INFORMATION CHANGED NOT SPECIFIED TO SCISSORED CLIPS, CHANGED ALERT DATE AND RE-RAN MDR.

    Additional Manufacturer Narrative · 1

    (B)(4). THE ANALYSIS RESULTS FOUND THAT THE DEVICE WAS RETURNED IN GOOD VISUAL CONDITION. IN AN ATTEMPT TO REPLICATE THE REPORTED INCIDENT, THE DEVICE WAS TESTED FOR FUNCTIONALITY. UPON TESTING, THE DEVICE WAS CYCLED, FED, AND FORMED THE REMAINING CLIPS AS MALFORMED. IN ADDITION, THE DEVICE LOCKED OUT AS INTENDED. PLEASE NOTE THAT PRIOR TO LOADING A CLIP IN THE JAWS, ENSURE THAT THE DEMARCATION BETWEEN THE JAWS AND THE DEVICE SHAFT IS PAST THE END OF THE TROCAR CANNULA. ADDITIONALLY, EXCESSIVELY APPLYING A SIDE LOAD TO THE JAWS, CAUSING THEM TO PARTIALLY COLLAPSE COULD RESULT IN A CLIP MALFORMATION. THE DEVICE JAWS SHOULD BE FULLY OPEN AND PARALLEL UPON INITIATING THE FIRING OF THE DEVICE. THE BATCH RECORD WAS REVIEWED AND NO ANOMALIES WERE NOTED DURING THE MANUFACTURING PROCESS.

    Additional Manufacturer Narrative · 1

    (B)(4). INFORMATION WAS NOT PROVIDED BY THE INITIAL CONTACT. INFORMATION ANTICIPATED, BUT UNAVAILABLE AT THIS TIME. ADDITIONAL INFORMATION: DO YOU KNOW WHAT THE ACCOUNT MEANT WHEN THEY STATED THAT THE DEVICE MISFIRED? THEY TOLD ME THE CLIP WAS SCISSORED, NOT FORMED PROPERLY. WAS THERE ANY PATIENT CONSEQUENCE? IF SO PLEASE EXPLAIN. NO.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT DURING A LAPAROSCOPIC CHOLECYSTECTOMY PROCEDURE, THE DEVICE MISFIRED. CASE COMPLETED WITH ANOTHER DEVICE OF THE SAME PRODUCT CODE. UNKNOWN IF THERE WERE NO PATIENT CONSEQUENCES.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT DURING A LAPAROSCOPIC CHOLECYSTECTOMY PROCEDURE, THE DEVICE MISFIRED. CASE COMPLETED WITH ANOTHER DEVICE OF THE SAME PRODUCT CODE. UNKNOWN IF THERE WERE NO PATIENT CONSEQUENCES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    281858 LIGAMAX-5MM ENDO CLIP APPLIER CLIP, IMPLANTABLE FZP ETHICON ENDO-SURGERY, LLC. NA K4CN4M

    Patients

    Seq Age Sex Outcome Treatment
    1