MAUDE Adverse Event Report: DEPUY MITEK LLC US VAPR S90 4.0MM W/INTEGR HDP -EA; ENDOSCOPIC ELECTROSURGICAL ELECTRODE, BIPOLAR, SINGLE USE

Catalog Number 225370

Device Problem Loss of or Failure to Bond (1068)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 10/25/2019

Event Type  malfunction  

Manufacturer Narrative

Product complaint # (b)(4).If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.(b)(4).

Event Description

It was reported by the affiliate via phone that during an arthroscopic surgery the vapr s90 4.0mm w/integr hdp -ea was connected and it did not cut and it did not coagulate.There was no alert code showed in the screen.The procedure was completed using another device.No patient consequence and no surgical delay was reported.No additional information was provided.In house laboratory testing found the returned device had no output when activated.The device was sent to the supplier for an in-depth investigation.

Manufacturer Narrative

Product complaint # (b)(4).Depuy synthes is submitting this report pursuant to the provisions of 21 cfr, part 803.This report may be based on information which depuy synthes has not been able to investigate or verify prior to the required reporting date.This report does not reflect a conclusion by fda, depuy synthes or its employees that the report constitutes an admission that the device, depuy synthes, or its employees caused or contributed to the potential event described in this report.Device was used for treatment, not diagnosis.If information is obtained that was not available for the initial medwatch, a follow-up medwatch will be filed as appropriate.Investigation summary : the device was received and evaluated.The complaint can be confirmed.It was observed that the active tip of the device appeared activated and saline residue was present in the suction tubing indicating that the device had been previously used.The device was connected to a test generator to test the functionality of the device.The device was activated in both ablate and coagulate modes for several seconds, and neither were successfully activated.The device was forwarded to the manufacturer for further investigation into the observed failures.The manufacturer indicated that the active continuity of the device was out of specification.The handle of the devices was opened to further investigate the electrical defects.There was an breakdown in active continuity across the electrical crimp.The evidence observed is consistent with previous devices that have been investigated under capa which has identified the components used in the process are not compatible for this method of joining.The root cause for the activation issues was determined to be due to design faults which led to a breakdown in the continuity of the active circuit.The devices investigated for this case were produced before corrective action was taken and before design changes were implemented.A manufacturing record evaluation was performed for the finished device lot numbers and product code, and no non-conformances were identified.At this point, no further action is warranted.However, depuy synthes mitek will continue to track any related complaints within this device family as a means of monitoring the extent with which this complaint is observed in the field.Udi: (b)(4).

• Brand Name: VAPR S90 4.0MM W/INTEGR HDP -EA
• Type of Device: ENDOSCOPIC ELECTROSURGICAL ELECTRODE, BIPOLAR, SINGLE USE
• Manufacturer (Section D): DEPUY MITEK LLC US; 325 paramount drive; raynham MA 02767
• MDR Report Key: 9355300
• MDR Text Key: 208326617
• Report Number: 1221934-2019-59663
• Device Sequence Number: 1
• Product Code: GEI
• UDI-Device Identifier: 10886705009398
• UDI-Public: 10886705009398
• Combination Product (y/n): N
• PMA/PMN Number: K122425
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: foreign
• Type of Report: Initial,Followup
• Report Date: 11/01/2019

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 11/21/2019
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 11/30/2021
• Device Catalogue Number: 225370
• Device Lot Number: U1812011
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 11/14/2019
• Date Manufacturer Received: 12/17/2019
• Patient Sequence Number: 1