inforMED
MalfunctionJOS

NEEDLE ELECTRODE

Received Jan 22, 2021 · Event occurred Oct 21, 2020

Report 1222993-2021-00002 · MDR key 11216565

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Product code (JOS)
Manufacturer (Cynosure, Llc)
Model (A3D/OS)

Device

Generic name

Needle Electrode

Manufacturer

Cynosure Llc

Catalog number

A3D/OS

Product problems

  • Device Dislodged or Dislocated
  • Device Dislodged or Dislocated

Patient

Not reported

  • No Clinical Signs, Symptoms or Conditions
  • No Clinical Signs, Symptoms or Conditions

Narrative

Additional Manufacturer Narrative

NO PATIENT INJURY WAS REPORTED. ALTHOUGH ADDITIONAL TREATMENT INFORMATION WAS REQUESTED, THERE WAS NO ADDITIONAL INFORMATION MADE AVAILABLE FROM THE CUSTOMER SITE DESPITE MULTIPLE REQUESTS. THE DEVICE HISTORY RECORD CONFIRMS THAT THE PRODUCT PASSED AND MET ALL REQUIREMENTS BEFORE RELEASING. IF THIS INCIDENT WERE TO RECUR, THERE IS A POSSIBILITY OF PATIENT INJURY LEADING TO PERMANENT IMPAIRMENT OF A BODY STRUCTURE AND THERE THIS INCIDENT IS REPORTABLE. IF ADDITIONAL RELEVANT DATA BECOMES AVAILABLE A FOLLOW UP REPORT WILL BE SUBMITTED.

Description of Event or Problem

IT WAS REPORTED THAT THE ELECTRODE NEEDLE DISENGAGED FROM THE ELECTRODE HOLDER AND FELL INTO THE PATIENT'S MOUTH.