MAUDE Adverse Event Report: ETHICON ENDO-SURGERY, LLC. ULTRACISION * SURG DEV, BLADES 5MM, ENDO; INSTRUMENT, ULTRASONIC SURGICAL

Catalog Number HDH05

Device Problem Loss of Power (1475)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 11/25/2015

Event Type  malfunction  

Manufacturer Narrative

(b)(4).Additional information was received: after the operation, the blade tip was broken off and the broken tip will be returning with the device.The device was returned with the distal tip of the blade broken off and returned.The remaining blade portion was scratched, and with evidence of contact with metal in or out of the operative field.This blade tip portion may have broken off of the device during transport to our analysis site.The reported complaint was for: ¿activation issues." the device was functionally tested with a generator.During functional testing on gen04 an error code 5 was displayed.A probable cause of the device not activating and displaying an error code 5 is blade damage.Probable causes of blade damage, including breakage, are external contact during pre-op or general use, blade contact with other devices, staples or clips during the procedure or using any means other than the blade wrench to attach or detach the blade.Once minor blade damage has occurred, subsequent activations may increase damage severity and result in an error code 5 or blade lockout later in the procedure.The generator system will revert to standby mode, when the audible alarm (solid tone) and visual alarm indicator appear.The batch record was reviewed and no anomalies were noted during the manufacturing process.

Event Description

It was reported that during a laparoscopic cholecystectomy, the device suddenly became not to be activated soon at the third actuation.Another device was used to complete the case.There were no adverse consequences to the patient.

• Type of Device: INSTRUMENT, ULTRASONIC SURGICAL
• Manufacturer (Section D): ETHICON ENDO-SURGERY, LLC.; 475 calle c; guaynabo PR 00969
• Manufacturer (Section G): ETHICON ENDO-SURGERY, LLC; 475 calle c; guaynabo PR 00969
• Manufacturer Contact: milton garrett ; 4545 creek road ml 120a; cincinnati, OH 45242 ; 5133378865
• MDR Report Key: 5347566
• MDR Text Key: 35558601
• Report Number: 3005075853-2016-00102
• Device Sequence Number: 1
• Product Code: LFL
• Combination Product (y/n): N
• Reporter Country Code: JA
• PMA/PMN Number: K990362
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,foreig
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 11/26/2015

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: Health Professional
• Device Expiration Date: 10/11/2019
• Device Catalogue Number: HDH05
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 12/10/2015
• Is the Reporter a Health Professional?: No
• Initial Date Manufacturer Received: 12/17/2015
• Initial Date FDA Received: 01/06/2016
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 11/11/2014
• 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