FDA Adverse Event Malfunction Summary report: N

ECLIPSE ELITE MICROPEN

MDR report key: 8469845 · Received March 29, 2019

Report

Report Number
MW5085389
Event Type
Malfunction
Date Received
March 29, 2019
Date of Event
March 12, 2019
Report Date
March 19, 2019
Manufacturer
ECLIPSE MEDCORP
Product Code
GFE
Product Problem
Yes
Report Source
Voluntary report
Reporter Location
AZ, US
Reporter Occupation
DENTIST

Narratives

Description of Event or Problem · 1

A (B)(6) YO MALE PATIENT WITH DX OF SIGNIFICANT PERIORAL RHYTIDS. PRP BLOOD DRAW MIXED WITH HA AND APPLIED TO TX AREA. MICRONEEDLED TX AREA WITH ECLIPSE ELITE MICROPEN SEVERAL PASSES. UPON CESSATION OF TX, REMOVED ECLIPSE ELITE NEEDLE CARTRIDGE AND OBSERVED BLOOD (STILL WET) DEEP INSIDE MOTOR CHAMBER. UNABLE TO REMOVE OR CLEAN. CONTACTED ECLIPSE VIA PHONE AND WAS TOLD THAT ECLIPSE AESTHETICS DOES NOT SELL THE ELITE IN THE USA. I INFORMED CUSTOMER SERVICE AGENT THAT DEVICE WAS PURCHASED IN (B)(6) 2018 FROM (B)(6) - SALES REP. ECLIPSE AESTHETICS INFORMED ME THAT I NEEDED TO CONTACT (B)(6) AND THAT ECLIPSE AESTHETICS HAS NOTHING TO DO WITH SALES OF THE ELITE IN THE USA. CUSTOMER SERVICE REP REFUSED TO TAKE REPORT OF MALFUNCTION. BLOOD RESIDUE PHOTOGRAPHED. I OWN TWO OTHER ECLIPSE ELITE MICROPENS PURCHASED AFTER (B)(6) 2018. SN'S (B)(4). UPON INSPECTION ON (B)(6) 2019, BLOOD RESIDUE WAS OBSERVED AND PHOTOGRAPHED. I AM WILLING TO SEND THE DEVICES TO FDA FOR INSPECTION. CARTRIDGES USED WERE FROM LOT #ECL020030-180719 WITH EXPIRATION OF 19-JUL-2021. CARTRIDGES DISPOSED OF IN SHARPS CONTAINER.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
260430 ECLIPSE ELITE MICROPEN BRUSH, DERMABRASION POWERED GFE ECLIPSE MEDCORP MP-1001-11 ECL020030-180719
260431 ECLIPSE ELITE MICROPEN BRUSH, DERMABRASION POWERED GFE ECLIPSE MEDCORP MP-1001-11
260432 ECLIPSE ELITE MICROPEN BRUSH, DERMABRASION POWERED GFE ECLIPSE MEDCORP MP-1001-11

Patients

Seq Age Sex Outcome Treatment
1 52 YR