MAUDE Adverse Event Report: NOVO SURGICAL INC. NOVO SURGICAL INC.; ZENITH ROCHESTER-OCHSNER FORCEPS, 1X2 TEETH, STRAIGHT, 8"" (20.3 CM)

Model Number G92723-31

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problem Tooth Fracture (2428)

Event Date 05/19/2021

Event Type  malfunction  

Event Description

Novo surgical inc.Received a sus voluntary event report from the fda (report mw5101478) notifying it of a mdr submitted by the a user/facility with regards to a zenith rochester-ochsner forceps, 1x2 teeth, straight,(item no.G92723-31) supplied by novo surgical.The fda correspondence dated (b)(6) , 2021 was delivered via postal mail and received by novo surgical on (b)(6), 2021.This was the first notification to novo surgical of this complaint.The sus voluntary event report indicated that an event that happened on (b)(6) 2021 was reported to the fda, by the user facility on (b)(6), 2021.The event indicates a serious injury where the teeth and the ridge of the kocher were reported to be broken.The sus voluntary event report from the fda (report mw5101478) was the first notification received by novo surgical of the event.No notification from the user facility was received by novo surgical prior to the sus voluntary report from the fda.

Manufacturer Narrative

Sus voluntary report from the fda (mw5101478) was the first report received by novo surgical for an event reported for novo surgical item code g92723-31.Novo surgical started its preliminary investigation by reviewing the device history records of the item for any similar complaints or non-conformities.No similar issues or non-conformities were noted for this particular item.Although the initial report submitted to the fda, by the user facility, indicated a serious injury, no patient associated injuries were reported by the user facility to novo surgical.In addition to this, the user facility reported to novo surgical that the breakage was observed at the time of cleaning the instruments.Additional information was requested from the user facility and the reported devices were requested to be returned back for evaluation.However, to this date, the user facility has not been willing to return the items back for evaluation.In addition to this, specific information about the product associated usage or its malfunction, were not provided by the user facility.As a result of this, it is difficult to determine if the event occured due to product malfunction or due to any user related errors.As a part of novo surgical's investigation, a brand new item from stock was sent out to an independent laboratory for specification analysis.Continued efforts of obtaining event associated information are also being taken.If the device becomes available for evaluation, a follow up report will be submitted.

• Brand Name: NOVO SURGICAL INC.
• Type of Device: ZENITH ROCHESTER-OCHSNER FORCEPS, 1X2 TEETH, STRAIGHT, 8"" (20.3 CM)
• Manufacturer (Section D): NOVO SURGICAL INC.; 700 commerce drive; oakbrook IL 60523
• MDR Report Key: 12155484
• MDR Text Key: 282045981
• Report Number: 3008770252-2021-00004
• Device Sequence Number: 1
• Product Code: GEN
• Combination Product (y/n): N
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: other
• Type of Report: Initial
• Report Date: 07/12/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: No Information
• Device Model Number: G92723-31
• Device Catalogue Number: G92723-31
• Was Device Available for Evaluation?: No
• Initial Date Manufacturer Received: 06/12/2021
• Initial Date FDA Received: 07/12/2021
• Patient Sequence Number: 1