MAUDE Adverse Event Report: US SURGICAL PUERTO RICO EEA; STAPLER, SURGICAL

Model Number EEAXL25

Device Problems Break (1069); Failure to Form Staple (2579); Detachment of Device or Device Component (2907); Human-Device Interface Problem (2949); Noise, Audible (3273)

Patient Problems Failure to Anastomose (1028); Tissue Breakdown (2681)

Event Date 03/14/2024

Event Type  malfunction  

Event Description

According to the reporter, during an ivor lewis esophagectomy procedure, when performing the anastomosis, the surgeon was squeezing the handle stating that the safety was not letting go.The surgeon kept squeezing, a snap was heard and the safety lever broke.All pieces of the lever was found.The surgeon kept using the stapler, when the handle was squeezed, the usual crunch sound was not heard.When the stapler was pulled the anvil was still attached, and the tissue rings were intact, but the ring part of the stapler was missing.Further dissection was required to do another anastomosis, and while doing it, they found inside the patient a full ring of staples loose as the staples did not form properly and the ring part of the stapler where it attaches to the anvil.

Manufacturer Narrative

Medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.Medtronic will submit a supplemental report if additional relevant information becomes known.

• Brand Name: EEA
• Type of Device: STAPLER, SURGICAL
• Manufacturer (Section D): US SURGICAL PUERTO RICO; 201 sabanetas industrial park; ponce PR 00716 4401
• Manufacturer (Section G): US SURGICAL PUERTO RICO; 201 sabanetas industrial park; ponce PR 00716 4401
• Manufacturer Contact: justin ellis ; 8200 coral sea st ne; mounds view, MN 55112 ; 7635265677
• MDR Report Key: 19088460
• MDR Text Key: 339926702
• Report Number: 2647580-2024-01583
• Device Sequence Number: 1
• Product Code: GAG
• UDI-Device Identifier: 10884523006056
• UDI-Public: 10884523006056
• Combination Product (y/n): N
• Reporter Country Code: CA
• PMA/PMN Number: K221003
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Health Professional,Company Representative
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date: 04/11/2024

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 04/11/2024
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: EEAXL25
• Device Catalogue Number: EEAXL25
• Device Lot Number: P3D0164
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 03/14/2024
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 04/11/2023
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1