BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RF GROUNDING PAD DISPOSABLE WITH CORD

    MDR report key: 8345777 · Received February 15, 2019

    Report

    Report Number
    3011270181-2019-00006
    Event Type
    Injury
    Date Received
    February 15, 2019
    Date of Event
    January 24, 2019
    Report Date
    January 30, 2019
    Manufacturer
    AVANOS MEDICAL INC.
    Product Code
    JOS
    UDI-DI
    20680651986065
    PMA / PMN Number
    K120476
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NJ, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    THE ACTUAL COMPLAINT PRODUCT WAS NOT RETURNED FOR EVALUATION. A REVIEW OF THE DEVICE HISTORY RECORD IS NOT POSSIBLE AS NO LOT NUMBER WAS PROVIDED. ALL INFORMATION REASONABLY KNOWN AS OF 15-FEB-2019 HAS BEEN INCLUDED IN THIS HEALTH AUTHORITY REPORT. SHOULD ADDITIONAL INFORMATION BE OBTAINED, A FOLLOW-UP HEALTH AUTHORITY REPORT WILL BE PROVIDED. THE INFORMATION PROVIDED BY AVANOS MEDICAL, INC. REPRESENTS ALL OF THE KNOWN INFORMATION AT THIS TIME. DESPITE GOOD FAITH EFFORTS TO OBTAIN ADDITIONAL INFORMATION, THE COMPLAINANT / REPORTER WAS UNABLE OR UNWILLING TO PROVIDE ANY FURTHER PATIENT, PRODUCT, OR PROCEDURAL DETAILS TO AVANOS MEDICAL, INC. AVANOS MEDICAL, INC. HAS NO INDEPENDENT KNOWLEDGE OF THE EVENT REPORTED BUT IS RELAYING THE INFORMATION THAT WAS PROVIDED BY THE USER FACILITY WHERE THE INCIDENT OCCURRED. THIS PRODUCT INCIDENT IS DOCUMENTED IN THE AVANOS MEDICAL, INC. COMPLAINT DATABASE AND IDENTIFIED AS COMPLAINT COMP (B)(4).

    Description of Event or Problem · 1

    IT WAS REPORTED THE PATIENT SUSTAINED A SKIN BURN UNDER THE GROUNDING PAD AREA OF THE SKIN. THE PATIENT WAS DIABETIC. THE PATIENT HAD A LEFT THREE LEVEL LUMBAR STANDARD RADIO FREQUENCY ABLATION (SRA) ON (B)(6) 2019. THE GROUNDING PAD WAS PLACED ON THE BACK OF THE UPPER LEFT THIGH. THE PATIENT WAS NOT HAIRY AND THE GROUNDING PAD ADHESION APPEARED NORMAL. THE PROCEDURE PROCEEDED WITHOUT INCIDENT WITH BOTH MOTOR AND SENSORY TESTING, NO HIGH IMPEDANCES NOR WARNINGS ON PAIN MANAGEMENT GENERATOR (PMG). SIX DAYS AFTER THE PROCEDURE THE PATIENT WENT TO THE EMERGENCY ROOM (ER) WITH REPORT OF A BURN AT GROUNDING PAD SITE. THE NURSE REVIEWED THE SKIN AND DESCRIBED THE SKIN AS A FULL THICKNESS CIRCULAR WOUND THE SIZE OF A DIME. IT IS UNKNOWN WHAT TREATMENT WAS DONE IN THE ER. NO ADDITIONAL INFORMATION WAS PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    138552 RF GROUNDING PAD DISPOSABLE WITH CORD STANDARD RF CABLES & ACCESSORIES JOS AVANOS MEDICAL INC. PMA-GP-BAY UNKNOWN 20680651986065

    Patients

    Seq Age Sex Outcome Treatment
    1