inforMED
InjuryFST

MAXENON XI 300-WATT XENON LIGHT SOURCE

Received Jan 16, 2014 · Event occurred Jul 23, 2013

Report 3005775121-2014-00001 · MDR key 3581602

Device

Generic name

Maxenon Xi 30-watt Xenon Light Source

Manufacturer

Qed, Inc

Model number

BFW 3010

Lot number

NI

Product problems

  • Insufficient Device Problem Information

Patient

Not reported

  • Burn, Thermal

Narrative

Description of Event or Problem

(B)(4) REC'D NOTIFICATION ON 12/09/2013 THAT A PATIENT REC'D A BURN ON HIS LIP FROM A MEDTRONIC LARYNGOSCOPE DURING LARYNGEAL SURGERY. IT WAS REPORTED THAT THE LARYNGOSCOPE WAS CONNECTED TO A (B)(4) MAXENON XI 300-WATT XENON LIGHT SOURCE. (B)(4) HAS NOT BEEN CONTACTED BY THE FACILITY NOR WAS IT INFORMED OF AN ISSUE AT THE TIME OF THE OCCURRENCE AND HAS NOT REC'D THE LIGHT SOURCE FOR INVESTIGATION.

Additional Manufacturer Narrative

(B)(4) WAS THE DISTRIBUTOR OF THIS PRODUCT AT THE TIME OF THE OCCURRENCE. (B)(4) NO LONGER SELLS THIS PRODUCT. THE MANUFACTURER IS QED, INC. (B)(4) WAS NOT MADE AWARE OF THE OCCURRENCE BY THE FACILITY BUT BY THE MANUFACTURER OF THE LARYNGOSCOPE, (B)(6). (B)(4) HAS NOT REC'D THE LIGHT SOURCE TO CONDUCT AN INVESTIGATION. (B)(4) HAS NO RECORDS OF THE LIGHT SOURCE SENT IN FOR REPAIR AT ANY TIME NOR IS THERE A RECORD OF THE FACILITY PURCHASING REPLACEMENT LAMPS FROM (B)(4).