MAUDE Adverse Event Report: VOLCANO CORPORATION INTRASIGHT MOBILE SYSTEM; SYSTEM, IMAGING, PULSED ECHO, ULTRASONIC

Model Number 797415

Device Problem Sharp Edges (4013)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 11/15/2023

Event Type  malfunction  

Event Description

It was reported that the intrasight mobile system touchscreen monitor fell off the table and the glass broke with sharp edges observed.The glass was cleaned up with no incident, and the touchscreen monitor was removed from the area.There was no patient present and no user injury reported.This product problem is being reported in an abundance of caution because the touchscreen monitor glass has sharp edges that can result in a potential for harm.

Manufacturer Narrative

This case was reviewed and investigated according to the manufacture¿s policy.Blocks a2-a5: no patient involvement.Blocks b6 & b7: no patient involvement.Block c: not applicable.Block d4: expiration date is not applicable.Blocks d6, d7, & d10: not applicable; no patient involvement.Blocks h3 & h6: the intrasight mobile touchscreen monitor was not returned for evaluation, thus no returned product investigation was performed.Blocks h7 & h9: do not apply to this submission.Submission of this report does not, in itself, represent a conclusion by the manufacturer and/or authorized representative or the national competent authority that the content of this report is complete or accurate, that the medical device(s) listed failed in any manner and/or that the medical device(s) caused or contributed to an alleged death or deterioration in the state of the health of any person.

• Brand Name: INTRASIGHT MOBILE SYSTEM
• Type of Device: SYSTEM, IMAGING, PULSED ECHO, ULTRASONIC
• Manufacturer (Section D): VOLCANO CORPORATION; 3721 valley centre drive #500; san diego CA 92130
• Manufacturer (Section G): VOLCANO CORPORATION; 3721 valley centre drive #500; san diego CA 92130
• Manufacturer Contact: ayse kharodawala ; 3721 valley centre drive #500; san diego, CA 92130 ; 858720-406
• MDR Report Key: 18322026
• MDR Text Key: 330467455
• Report Number: 3008363989-2023-00052
• Device Sequence Number: 1
• Product Code: IYO
• UDI-Device Identifier: 00845225012915
• UDI-Public: (01)00845225012915(11)221101(10)1426612305
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K203719
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional,Company Representative
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date: 12/13/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 12/13/2023
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 797415
• Device Catalogue Number: 797415
• Device Lot Number: 1426612305
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 11/01/2022
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1