FDA Adverse Event Malfunction Summary report: N

FORMATK MAGMA PLATFORM

MDR report key: 9569684 · Received January 8, 2020

Report

Report Number
MW5092130
Event Type
Malfunction
Date Received
January 8, 2020
Date of Event
May 22, 2016
Report Date
January 6, 2020
Manufacturer
FOMATK SYSTEMS, LTD
Product Code
GEX
Product Problem
Yes
Report Source
Voluntary report
Reporter Location
GB
Reporter Occupation
501

Narratives

Description of Event or Problem · 1

THE (B)(6) LASER CLINIC LIMITED ((B)(6)) PURCHASED 6 GRADE 4 LASERS DESIGNED BY THE MANUFACTURER REFERRED TO IN THIS DOCUMENT VIA ITS (B)(4) DISTRIBUTOR. ON THIS OCCASION (AND THERE WERE OTHERS) ONE OF THE LASERS CAUSED SERIOUS AND SIGNIFICANT BURNS TO THE BACK OF THE PATIENT ((B)(6)). (B)(6) HAS SUCCESSFULLY SUED THE (B)(4) DISTRIBUTOR IN THE HIGH COURT IN (B)(6) AND WAS, ON (B)(6) 2019, AWARDED DAMAGES OF THE GBP EQUIVALENT OF (B)(6) PLUS COSTS FOR CLAIMS/WARRANTIES MADE BY THE DISTRIBUTOR. (B)(6) NOW WISHES TO NOTIFY THE FDA OF THE MATERIAL AND MAJOR SAFETY ISSUES ASSOCIATED WITH THESE LASERS AND THE CLAIMS MADE (AND CONTINUE TO BE MADE) BY THE MANUFACTURER AS THESE MACHINES CAN CAUSE SERIOUS AND PERMANENT INJURY TO INDIVIDUALS. MAGMA LASER (510K REF K 153566). FDA SAFETY REPORT ID # (B)(4).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
29610 FORMATK MAGMA PLATFORM POWERED LASER SURGICAL INSTRUMENT GEX FOMATK SYSTEMS, LTD

Patients

Seq Age Sex Outcome Treatment
1 45 YR Other