LEGEND FOOTED ATTACHMENT
Report
- Report Number
- 1625507-2013-00036
- Event Type
- Malfunction
- Date Received
- July 29, 2013
- Report Date
- June 27, 2013
- Manufacturer
- MDT POWERED SURGICAL SOLUTIONS
- Product Code
- HBB
- PMA / PMN Number
- K020069
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- TN, US
- Reporter Occupation
- OTHER
Narratives
REPORT CONFIRMED. EVALUATION DETERMINED THAT THE FOOTED PORTION WAS DAMAGED BY TOOL CONTACT. A PORTION OF THE FOOT OF THE ATTACHMENT WAS DETACHED AND MISSING. THE LIKELY CAUSES ARE IDENTIFIED AS DEBRIS IN THE COLLET AND IMPROPER INSERTION OF THE TOOL. (B)(4) WAS INITIATED TO INVESTIGATE THIS MALFUNCTION. THE USER MANUAL CONTAINS THE FOLLOWING WARNING ¿THE ATTACHMENT SHOULD NOT BE USED IF ANY PART OF THE ATTACHMENT APPEARS TO BE BENT, LOOSE, MISSING, OR DAMAGED. EXCESSIVE PRESSURE OR IMPROPER HANDLING, SUCH AS BENDING OR PRYING, OF THE ATTACHMENT OR DISSECTING TOOL MAY CAUSE INJURY TO THE PATIENT, OPERATOR AND/OR OPERATING ROOM STAFF." IN ADDITION, ¿A TACTILE AND AUDIBLE CLICK WILL BE OBSERVED WHEN ATTACHMENT IS FULLY SEATED. TACTILE FEEDBACK IS FELT WHEN THE DISSECTING TOOL IS FULLY SEATED. TURN THE TOOL LOCKING RING TO THE ¿LOCK¿ POSITION. VERIFY THAT THE TOOL IS IN PLACE BY GENTLY PULLING ON THE TOOL.¿ THE PREVENTIVE MAINTENANCE/SERVICE MANUAL FOR THE LEGEND SYSTEM SPECIFIES SERVICE INTERVALS FOR DEVICES BASED ON THE HOSPITAL U SAGE LEVEL. THE MAXIMUM SPECIFIED SERVICE INTERVAL IS 24 MONTHS. DEVICE HAS BEEN IN USE FOR APPROXIMATELY 88 MONTHS WITH NO RECORD OF FACTORY SERVICE DURING THIS PERIOD. WE WILL CONTINUE TO MONITOR THIS COMPLAINT TYPE FOR TRENDS. (B)(4).
DEVICE RETURNED FOR NON-SPECIFIED REPAIR. NO PATIENT IMPACT REPORTED. REPAIR ESCALATED TO COMPLAINT ON EVALUATION DUE TO THE FOOTED PORTION BEING DAMAGED BY TOOL CONTACT. ON FOLLOW-UP, IT WAS REPORTED THAT THE MALFUNCTION WAS DISCOVERED BY A SCRUB TECH. IT WAS CONFIRMED THAT THERE WAS NO PATIENT IMPACT.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 354189 | LEGEND FOOTED ATTACHMENT | MOTOR, DRILL, PNEUMATIC | HBB | MDT POWERED SURGICAL SOLUTIONS | N/A | N/A |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 |