MAUDE Adverse Event Report: AESCULAP AG BIPOLAR COAGULATION UNIT

Model Number	GN060
Medical Device Problem Code	Power Problem (3010)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/01/2021
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Investigation results: as of the date of this report the complaint product was not provided for investigation.Therefore, a thorough investigation is not possible.Batch history review: the device quality and manufacturing history records have been checked for the available lot number and were found to be according to our specifications valid at the time of production.Review of the complaint history revealed that no similar complaints have been filed against products from this batch number.Conclusion and measures / preventive measures: based upon the investigation results a clear root cause conclusion cannot be drawn.There is no indication for a material-, manufacturing- or design-related failure.In the event that the complaint product will be provided for investigation in the future, an update of this report will be provided unsolicited.Based upon the investigations results a capa is not necessary.
Event or Problem Description
It was reported to aesculap ag that a bipolar coagulation unit (part # gn060) was tested prior to a procedure set to be performed on (b)(6) 2021.According to the complainant, prior to the operation, the bipolar coagulator was tested, and was found to have no output.The device was replaced.The complaint device was not returned to the manufacturer for evaluation.No patient involvement.Additional information was not provided nor available / was not available.The malfunction is filed under aag reference (b)(4).

• Brand Name: BIPOLAR COAGULATION UNIT
• Common Device Name: BIPOLAR COAGULATION
• Manufacturer (Section D): AESCULAP AG; po box 40; tuttlingen, 78501 ; GM 78501
• MDR Report Key: 11734657
• Report Number: 9610612-2021-00329
• Device Sequence Number: 19840323
• Product Code: GEI
• UDI-Device Identifier: 04038653078035
• UDI-Public: 4038653078035
• Combination Product (Y/N): N
• Initial Reporter Country: CH
• PMA/510(K) Number: K952524
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 04/27/2021

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
• Operator of Device: Health Professional
• Device Model Number: GN060
• Device Catalogue Number: GN060
• Device Lot Number: 51685749
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 03/31/2021
• Initial Report FDA Received Date: 04/27/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1