inforMED
MalfunctionLQJ

HGM

Received Jun 12, 2002 · Event occurred May 20, 2002

Report 1720381-2002-00004 · MDR key 400077

Device

Generic name

Microscope Laser Filter

Manufacturer

Fisma

Model number

K10-A-K08-1-73

Catalog number

ZEISS THIN SHUTTER K8

Lot number

NA

Product problems

  • Intraprocedure, fire or flash during
  • Device Displays Incorrect Message

Patient

*

  • Therapy/non-surgical treatment, additional

Narrative

Description of Event or Problem

DOCTOR STARTED THE PROCEDURE AND THE FIRST TIME HE FIRED THE LASER HE REPORTED SEEING A GREEN FLASH OF LIGHT. FOR THE REST OF THE PROCEDURE HE WORE SAFETY FILTER GLASSES AND COMPLETED THE PROCEDURE. THERE WAS NO INJURY TO THE PATIENT. LATER THE DOCTOR WAS CHECKED BY THE OPHTHALMOLOGY DEPARTMENT OF THE CLINIC AND NO INJURY WAS FOUND . BIO-TECH REPORTED THAT THERE WERE NO ERROR CODES INDICATING A FAULT CONDITION IN THE LASER SYSTEM DURING THE PROCEDURE. LATER IN THE DAY THE SHUTTER WAS CAUSED TO MALFUNCTION BY CLINIC STAFF AND AN ERROR CODE DID PREVENT THE LASER FROM FIRING. THE DEVICE THEN WAS PACKAGED AND RETURNED TO MANUFACTURER FOR EVALUATION.