inforMED
MalfunctionGET

JAW INS.MARYLAND DISSECTOR 3.5MM 290MM

Received Jan 31, 2018 · Event occurred Jan 9, 2018

Report 9610612-2018-00024 · MDR key 7232641

Device

Generic name

Endoscopy

Manufacturer

Aesculap Ag

Model number

PO342R

Catalog number

PO342R

Product problems

  • Break
  • Break

Patient

Not reported

  • No Known Impact Or Consequence To Patient
  • No Known Impact Or Consequence To Patient

Narrative

Additional Manufacturer Narrative

EXEMPTION NUMBER: E2014018. MANUFACTURING SITE EVALUATION: EVALUATION ON-GOING

Description of Event or Problem

(B)(6). DURING THE PROCEDURE FOR OVARIAN CYSTECTOMY, THE JAW WAS BROKEN TO PIECES BY HOLDING MEMBRANE TISSUE AND PULLING IT UP. THE BROKEN PARTS DROPPED INSIDE OF THE PATIENT. THE CUSTOMER MANAGED TO REMOVE THE BROKEN PARTS, HOWEVER, A FRAGMENT APPROX. 2MM LENGTH WAS FOUND INSIDE OF THE PATIENT BY X-RAY AFTER SURGERY.

Additional Manufacturer Narrative

INVESTIGATION: THE COMPONENTS HAVE BEEN EXAMINED VISUALLY AND MICROSCOPICALLY WITH A PANASONIC DMC TZ8 DIGITAL CAMERA. CONCLUSION AND ROOT CAUSE: THE ROOT CAUSE OF THE PROBLEM IS MOST PROBABLY USAGE RELATED. RATIONAL: ACCORDING TO THE QUALITY STANDARD AND DHR FILES, A MATERIAL DEFECT OR PRODUCTION ERROR CAN BE EXCLUDED. ADDITIONALLY ACCORDING TO THE REPORT OF THE QUALITY ASSURANCE OF THE PRODUCTION DEPARTMENT THERE IS NO PRODUCTION ERROR. THE BREAKAGE WAS CAUSED BY EXCESSIVE LATERAL STRESS. NO CAPA IS NECESSARY.