GREENLIGHT MOXY FIBER OPTIC
Report
- Report Number
- 2937094-2014-00560
- Event Type
- Malfunction
- Date Received
- June 30, 2014
- Date of Event
- June 6, 2014
- Report Date
- June 9, 2014
- Manufacturer
- AMERICAN MEDICAL SYSTEMS, INC. (SAN JOSE)
- Product Code
- GEX
- PMA / PMN Number
- NA
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- CA, US
- Reporter Occupation
- OTHER
Narratives
PRODUCT EVALUATION: FAILURE ANALYSIS FOR FIBER (B)(4): THE FIBER SHOWS A CIRCUMFERENTIAL FRACTURE DISTAL TO FIBER/CAP FUSION ZONE AT THE BEVEL EDGE; THE FIBER PROXIMAL TO FRACTURE CAN ROTATE INDEPENDENTLY OF METAL CAP; THE GLASS CAP EXHIBITS SEVERE DEVITRIFICATION AT OUTPUT WINDOW; THE METAL CAP IS MELTED AT THE OUTPUT WINDOW; THE OUTER FLOW TUBING EXHIBITS SCRATCH MARKS AT THE OPEN END. BASED ON THE ANALYSIS ABOVE, THE POTENTIAL FOR FORWARD FIRING MAY EXIST. PROBABLE ROOT CAUSE: BASED ON THE PRODUCT ANALYSIS RESULTS, THE PROBABLE ROOT CAUSE OF THE FAILURE IS: HEAT ACCUMULATION. CAP WEAR WAS ACCELERATED DUE TO ANATOMICAL/PROCEDURAL FACTORS (TISSUE CONTACT AND TECHNIQUE) ENCOUNTERED DURING THE PROCEDURE WHICH WOULD LIMIT THE PERFORMANCE OF THE FIBER. (B)(4).
IT WAS REPORTED THAT THE FIBER WOULD NOT COAGULATE AND THE TIP WAS LOOSE. THE PROCEDURE WAS COMPLETED USING A SECOND FIBER. THERE WAS "NO PATIENT INJURY" REPORTED. GLAND VOLUME 40 ML. JOULES USED 33,722. TIME EXPENDED 16:38 MINUTES.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 379424 | GREENLIGHT MOXY FIBER OPTIC | POWERED LASER SURGICAL INSTRUMENT | GEX | AMERICAN MEDICAL SYSTEMS, INC. (SAN JOSE) | 0010-2400 | 344A |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 |