FDA Adverse Event Malfunction Summary report: N

TISSUE EXPANDER

MDR report key: 5205 · Received April 27, 1993

Report

Report Number
5205
Event Type
Malfunction
Date Received
April 27, 1993
Date of Event
December 16, 1992
Manufacturer
MCGHUN CUSTOM
Product Problem
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

TISSUE EXPANDER INSERTED SEPTEMBER, 1992 FOR REPAIR OF ABDOMINAL DEFORMITY. ON DECEMBER 15, 1992 SHE WAS TAKEN TO SURGERY FOR NECROSIS OF RIGHT ABDOMINAL ADVANCEMENT FLAP. DURING THE COURSE OF SURGERY, THE ABDOMINAL TISSUE ESPANDER WAS REMOVED AND FOUND TO BE DEFECTIVE. THE EXPANDERS WERE LEAKING AT THE SUPERIOR BORDER AT JUNCTION OF SIDE WALLDEVICE 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: INVALID DATA. CONCLUSION: DEVICE FAILURE OCCURRED BUT NOT RELATED TO EVENT. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: INVALID DATA. CORRECTIVE ACTIONS: DEVICE DISCARDED. THE DEVICE WAS DESTROYED/DISPOSED OF.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 TISSUE EXPANDER Implant MCGHUN CUSTOM FH 5621

Patients

Seq Age Sex Outcome Treatment
1 56 YR Other