MAUDE Adverse Event Report: COVIDIEN MANSFIELD TRUCLEAR; HYSTEROSCOPE (AND ACCESSORIES)

Model Number 7209808

Device Problem Incorrect Measurement (1383)

Patient Problems Uterine Perforation (2121); Muscle/Tendon Damage (4532)

Event Date 02/03/2022

Event Type  Injury  

Manufacturer Narrative

If information is provided in the future, a supplemental report will be issued.

Event Description

According to the reporter, during hysteroscopy d<(>&<)>c/polypectomy, , fluid deficit level increased.Doctor visualized a perforation on the uterine fundal wall towards the patient's left cornua.Procedure was stopped.Doctor ordered post-op lasix and doxycycline for patient.There was no blood loss of 500cc or more.The patient had damage to uterine muscle (myometrium).

Manufacturer Narrative

If information is provided in the future, a supplemental report will be issued.

Event Description

According to the reporter, during hysteroscopy d<(>&<)>c/polypectomy, fluid deficit level increased.Doctor visualized a perforation on the uterine fundal wall towards the patient's left cornua.Procedure was stopped.Doctor ordered post-op lasix and doxycycline for patient.There was no blood loss of 500cc or more.The patient had damage to uterine muscle (myometrium).

• Brand Name: TRUCLEAR
• Type of Device: HYSTEROSCOPE (AND ACCESSORIES)
• Manufacturer (Section D): COVIDIEN MANSFIELD; 15 hampshire street; mansfield MA 02048
• Manufacturer (Section G): COVIDIEN MANSFIELD; 15 hampshire street; mansfield MA 02048
• Manufacturer Contact: tracy landers ; 5920 longbow drive; boulder, CO 80301 ; 3035816943
• MDR Report Key: 13580676
• MDR Text Key: 285968845
• Report Number: 1282497-2022-00023
• Device Sequence Number: 1
• Product Code: HIH
• UDI-Device Identifier: 10884521749931
• UDI-Public: 10884521749931
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K031787
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional,Company Representative
• Reporter Occupation: Physician
• Type of Report: Initial
• Report Date: 02/22/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 02/22/2022
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 7209808
• Device Catalogue Number: 7209808
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 02/03/2022
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unknown
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Age: 72 YR
• Patient Sex: Female
• Patient Weight: 91 KG