inforMED
MalfunctionGET

ENDO DISSECT

Received May 30, 2017 · Event occurred Dec 2, 2016

Report 2647580-2017-05508 · MDR key 6598697

Device

Generic name

Motor, Surgical Instrument, Pneumatic Powered

Model number

174213

Catalog number

174213

Lot number

P5K0131X

Product problems

  • Mechanics Altered
  • Mechanics Altered

Patient

Not reported

  • No Information
  • No Information

Narrative

Additional Manufacturer Narrative

POST MARKET VIGILANCE (PMV) LED AN EVALUATION OF ONE DEVICE. THE EVENT REPORT ALLEGES THE PRODUCT WAS USED IN A SURGICAL PROCEDURE. THE ARTICULATION KNOB WAS SHEARED OFF AND DETACHED FROM THE HANDLE. THE DEVICE COULD NO LONGER BE ARTICULATED. RECORDS FROM EACH MANUFACTURING LOT ARE THOROUGHLY REVIEWED TO ENSURE THAT PRODUCTS ARE RELEASED MEETING ALL QUALITY RELEASE SPECIFICATIONS AT THE TIME OF MANUFACTURE. ANALYSIS CONCLUDED THERE WERE NO ASSEMBLY COMPONENT RELATED FAILURES. REPLICATION OF THE REPORTED EVENT CAN OCCUR WHEN APPLYING EXCESSIVE FORCE TO THE ARTICULATION KNOB BY ROTATING TOO FAR AND FORCING IT. THE ROOT CAUSE OF THE OBSERVED DAMAGE WAS MISUSE OF THE PRODUCT WHICH WOULD HAVE CAUSED OR CONTRIBUTED TO THE REPORTED INCIDENT. SHOULD NEW INFORMATION BECOME AVAILABLE, THE FILE WILL BE RE-OPENED AND THE INVESTIGATION SUMMARY WILL BE AMENDED AS APPROPRIATE.

Description of Event or Problem

ACCORDING TO THE REPORTER: DURING THE PROCEDURE, THE LEVER WHICH IS USED TO ARTICULATE THE DEVICE WAS BROKEN.

Additional Manufacturer Narrative

EVALUATION SUMMARY: POST MARKET VIGILANCE (PMV) LED AN EVALUATION OF THE DEVICE. THE ARTICULATION KNOB WAS SHEARED OFF AND DETACHED FROM THE HANDLE. THE DEVICE COULD NO LONGER BE ARTICULATED. RECORDS FROM EACH MANUFACTURING LOT ARE THOROUGHLY REVIEWED TO ENSURE THAT PRODUCTS ARE RELEASED MEETING ALL QUALITY RELEASE SPECIFICATIONS AT THE TIME OF MANUFACTURE. ANALYSIS CONCLUDED THERE WERE NO ASSEMBLY COMPONENT RELATED FAILURES. REPLICATION OF THE REPORTED EVENT CAN OCCUR WHEN APPLYING EXCESSIVE FORCE TO THE ARTICULATION KNOB BY ROTATING TOO FAR AND FORCING IT. SHOULD NEW INFORMATION BECOME AVAILABLE, THE FILE WILL BE RE-OPENED AND THE INVESTIGATION SUMMARY WILL BE AMENDED AS APPROPRIATE. IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.

Description of Event or Problem

ACCORDING TO THE REPORTER: AS PER THE ADDITIONAL INFORMATION RECEIVED, PATIENT STATUS IS STABLE. THERE WAS NO PATIENT INJURY.