FDA Adverse Event Injury Summary report: N

OVERTUBE FOR LIGATOR

MDR report key: 959 · Received July 27, 1992

Report

Report Number
1221332-1992-00001
Event Type
Injury
Date Received
July 27, 1992
Report Date
July 1, 1992
Manufacturer
SUPERIOR HEALTH CARE GROUP, INC.
Adverse Event
Yes
Report Source
Distributor report
Reporter Location
CA
Reporter Occupation
UNKNOWN

Narratives

Description of Event or Problem · 1

THIS INFORMATION RELATES TO AN INTERNATIONAL EVENT AS PUBLISHED IN A JOURNAL ARTICLE {GOLDSCHMIEDT, MARKUS MD. " A SAFETY MANEUVER FOR PLACING OVERTUBE DURING ENDOSCOPIC VARICEAL LIGATION." GASTROENTEROLOGY ENDOSCOPY VOL. 38, NO. 3, 1992:399,400.} THEREFORE, TO DATE, WE HAVE BEEN UNABLE TO ESTABLISH ANY DETAILED INFORMATION. THE OVERTUBE WAS USED DURING AN ENDOSCOPIC LIGATION. WHEN THE OVERTUBE WAS PLACED IN THE ESOPHAGUS COAXIALLY WITH THE ENDOSCOPE, A PERFORATION OCCURRED. IT IS UNKNOWN HOW THE PATIENT WAS MANAGED AFTER THE EVENTINVALID DATA - REGARDING SINGLE USE LABELING OF DEVICE. PATIENT MEDICAL STATUS PRIOR TO EVENT: UNKNOWN. INVALID DATA - REGARDING 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. INVALID DATA - REGARDING WHETHER EVENT PRESENTS IMMINENT HAZARD. INVALID DATA - WHETHER DEVICE USED AS LABELED/INTENDED. INVALID DATA - REGARDING EVALUATION BY USER AFTER EVENT. METHOD OF EVALUATION: INVALID DATA. RESULTS OF EVALUATION: INVALID DATA. CONCLUSION: INVALID DATA. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: INVALID DATA. CORRECTIVE ACTIONS: NO DATA. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 OVERTUBE FOR LIGATOR SUPERIOR HEALTH CARE GROUP, INC. UNKNOWN

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention