inforMED
MalfunctionDWH

STERNUM BLADE

Received Jun 19, 2013 · Event occurred May 22, 2013

Report 0001811755-2013-01431 · MDR key 3178142

Device

Generic name

Blade, Saw, Surgical, Cardiovascular

Catalog number

0298097100

Lot number

13071017

Product problems

  • Break

Patient

Not reported

  • No Consequences Or Impact To Patient

Narrative

Description of Event or Problem

IT WAS REPORTED THAT DURING A STERNUM PROCEDURE, THE BLADE BROKE IN TWO PIECES. IT WAS ALSO REPORTED THAT A BROKEN PIECE FELL INTO THE PATIENT; IT WAS LOCATED 2CMS FROM THE HEART AND WAS REMOVED. IT WAS FURTHER REPORTED THAT THERE WAS NO ADVERSE CONSEQUENCES AS A RESULT OF THIS EVENT AND THE PROCEDURE WAS COMPLETED SUCCESSFULLY.

Additional Manufacturer Narrative

THE BLADE SUBJECT TO THIS MDR WAS NOT RETURNED TO THE MANUFACTURER FOR EVALUATION. IF THE PRODUCT IS RETURNED, A FOLLOW-UP MDR WILL BE SUBMITTED. DEVICE NOT RETURNED.

Description of Event or Problem

IT WAS REPORTED THAT DURING A STERNUM PROCEDURE, THE BLADE BROKE IN TWO PIECES. IT WAS ALSO REPORTED THAT A BROKEN PIECE FELL INTO THE PATIENT; IT WAS LOCATED 2CMS FROM THE HEART AND WAS REMOVED. IT WAS FURTHER REPORTED THAT THERE WAS NO ADVERSE CONSEQUENCES AS A RESULT OF THIS EVENT AND THE PROCEDURE WAS COMPLETED SUCCESSFULLY.

Additional Manufacturer Narrative

THE EXACT ROOT CAUSE CANNOT BE DETERMINED. HOWEVER INVESTIGATION RESULTS INDICATE THAT THE CRACK ORIGINATED AT THE BOTTOM OF THE LAST TOOTH. THE POSSIBLE CAUSE IS OVERLOADING OF THE BLADE DURING THE SURGERY, BUT THIS CANNOT BE CONFIRMED.