VITAL VUE
Received Oct 21, 2019 · Event occurred Oct 2, 2019
Report 2936999-2019-00882 · MDR key 9213611
Device
Generic name
Illuminator, Fiberoptic, Surgical Field
Manufacturer
Nellcor Puritan Bennett Mexico SaModel number
8886828206Catalog number
8886828206
Lot number
190880219K
Product problems
- Melted
- Melted
Patient
34 YR
- No Patient Involvement
- No Patient Involvement
Narrative
Additional Manufacturer Narrative
ADDITIONAL INFORMATION: D10, G4, H3, H6 H3 EVALUATION SUMMARY: POST MARKET VIGILANCE (PMV) LED AN EVALUATION OF ONE DEVICE. A VISUAL INSPECTION OF THE RETURNED PRODUCT NOTED THAT THE DEVICE HANDLE HAD BEEN MELTED AND THE POWER SOURCE INSIDE THE HANDLE HAD BEEN SEVERED IN HALF. FUNCTIONAL TESTING COULD NOT BE DONE BASED ON THE CONDITION THE DEVICE WAS RETURNED IN. RECORDS FROM EACH MANUFACTURING LOT ARE THOROUGHLY REVIEWED TO ENSURE THAT PRODUCTS ARE RELEASED MEETING ALL QUALITY RELEASE SPECIFICATIONS AT THE TIME OF MANUFACTURE. THE INVESTIGATION CONCLUDED THERE WERE NO ABNORMALITIES THAT WOULD HAVE CAUSED OR CONTRIBUTED TO THE REPORTED CONDITION. A DEFINITIVE ROOT CAUSE COULD NOT BE DETERMINED WITH REGARD TO THE REPORTED CONDITION DUE TO NOT BEING ABLE TO TEST BECAUSE THE DEVICES POWER SOURCE WAS DAMAGED. IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.
Additional Manufacturer Narrative
IF INFORMATION IS PROVIDED IN THE FUTURE, A SUPPLEMENTAL REPORT WILL BE ISSUED.
Description of Event or Problem
ACCORDING TO THE REPORTER, DURING ANTERIOR CERVICAL DISCECTOMY AND FUSION, THE DEVICE MELTED ON TABLE. ANOTHER DEVICE WAS OPENED AND DID THE CASE. THE PROBLEM WAS DISCOVERED BEFORE THE PRODUCT WAS USED ON THE PATIENT.