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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ETHICON ENDO-SURGERY, LLC. HARMONIC 1100 SHEARS, 20CM; INSTRUMENT, ULTRASONIC SURGICAL

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ETHICON ENDO-SURGERY, LLC. HARMONIC 1100 SHEARS, 20CM; INSTRUMENT, ULTRASONIC SURGICAL Back to Search Results
Catalog Number HAR1120
Device Problem Adverse Event Without Identified Device or Use Problem (2993)
Patient Problem Hematoma (1884)
Event Date 01/01/2024
Event Type  Injury  
Event Description
It was reported that after a thyroidectomy, due to a hematoma, they had to do a patient bring back for the device.
 
Manufacturer Narrative
(b)(4).Date sent: 2/6/2024 b3: event year only reported: 2024 d4 lot numbers: potential: x70242, x7034x, x7030r, x7026v d4 batch #: unknown attempts are being made to obtain the following information.To date, no response has been provided.If further details are received at a later date, a supplemental medwatch will be sent: what is the surgeon¿s experience with this device for this procedure? was the original procedure done in an open traditional manner or minimally invasive approach? if minimally invasive, can the approach/procedure be described in detail? what anatomical structures was the device used on? were the larger laryngeal blood vessels clipped and/or tied or was the harmonic used for ligation on those vessels? if the harmonic was used on the larger laryngeal blood vessels, what power level was used on the generator? were there any generator alert screens in the original procedure? can a generator log be pulled for engineering review? was the post op bleeding source identified? if yes, was it a vessel where the device was used? what was done in the secondary procedures to address the hematoma? were any blood products given to the patient after the hematoma was discovered? what is the patient's current status? is the rep and/or surgeon interested in a call to speak with ethicon medical and engineering? additional information was requested and the following was obtained: there were 3 different bring backs from 3 different cases.There were no issues with the 3 devices during the initial 3 cases the lot numbers of the devices were not recorded during the initial procedures but the potentially used lot numbers were added to the complaint so a dhr analysis could be performed for each lot.An analysis of the product could not be performed since a physical sample was not received for evaluation.A manufacturing record evaluation was performed for the potential finished device lot numbers, and no non-conformances were identified.As part of our company quality system process, all devices are manufactured, inspected, and distributed to approved specifications.This report is being submitted pursuant to the provisions of 21 cfr, part 803.This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by ethicon, or its employees that the report constitutes an admission that the product, ethicon, or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.
 
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Brand Name
HARMONIC 1100 SHEARS, 20CM
Type of Device
INSTRUMENT, ULTRASONIC SURGICAL
Manufacturer (Section D)
ETHICON ENDO-SURGERY, LLC.
475 calle c
guaynabo 00969
*  00969
Manufacturer (Section G)
ETHICON ENDO-SURGERY, LLC.
475 calle c
guaynabo 00969
*   00969
Manufacturer Contact
kate karberg
475 calle c
guaynabo 
*  
3035526892
MDR Report Key18652970
MDR Text Key334688913
Report Number3005075853-2024-01068
Device Sequence Number1
Product Code LFL
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
K200841  
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type Company Representative
Reporter Occupation Other
Type of Report Initial
Report Date 02/06/2024
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received02/06/2024
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? Yes
Device Operator Health Professional
Device Catalogue NumberHAR1120
Was Device Available for Evaluation? No
Date Manufacturer Received01/18/2024
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Is the Device Single Use? Yes
Type of Device Usage Initial
Patient Sequence Number1
Treatment
GENERATOR
Patient Outcome(s) Required Intervention;
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