inforMED
MalfunctionMVR

COUPLER

Received Apr 10, 2023 · Event occurred Mar 14, 2023

Report 1416980-2023-01656 · MDR key 16708703

Device

Generic name

Device, Anastomotic, Microvascular

Model number

NA

Catalog number

511100200060

Lot number

SP22F011679199

Product problems

  • Material Twisted/Bent
  • Material Twisted/Bent

Patient

Unknown

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

Narrative

Additional Manufacturer Narrative

H10: A DEVICE HISTORY REVIEW REVEALED NO ISSUES THAT COULD HAVE CAUSED OR CONTRIBUTED TO THE REPORTED ISSUE. THE DEVICE WAS NOT RECEIVED FOR EVALUATION; THEREFORE, A DEVICE ANALYSIS COULD NOT BE COMPLETED. SHOULD ADDITIONAL RELEVANT INFORMATION BECOME AVAILABLE, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

Additional Manufacturer Narrative

SHOULD ADDITIONAL RELEVANT INFORMATION BECOME AVAILABLE, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

Description of Event or Problem

IT WAS REPORTED THAT THE PINS OF A 2.0MM COUPLER WERE MISALIGNED OR BENT. THIS WAS IDENTIFIED DURING A PHALLOPLASTY FREE FLAP. THERE WAS NO REPORT OF PATIENT INJURY OR MEDICAL INTERVENTION ASSOCIATED WITH THIS EVENT. NO ADDITIONAL INFORMATION IS AVAILABLE.