MAUDE Adverse Event Report: MEDTRONIC XOMED INC. TRICUT STRAIGHT SHAFT 3.5MM 11CM LONG; BUR, EAR, NOSE AND THROAT

Model Number 1883504

Device Problem Material Fragmentation (1261)

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

Event Date 04/21/2021

Event Type  malfunction  

Manufacturer Narrative

If information is provided in the future, a supplemental report will be issued.

Event Description

A healthcare professional (hcp) reported that the blade tip was broken-detached about 5 minutes during the functional endoscopic sinus surgery.There were fragments that came off or got detached from the bur.The fragments get in contact with the patient and were removed by the use of forceps.There was a back-up device used.There was no patient impact.A healthcare professional (hcp) reported that the blade tip was broken-detached about 5 minutes during the functional endoscopic sinus surgery.There were fragments that came off or got detached from the bur.The fragments get in contact with the patient and were removed by the use of forceps.There was a back-up device used.There was no patient impact.

Manufacturer Narrative

H3: analysis found that visually, the inner cutter broke at the distal tip which would have resulted in the reported event.Upon magnification, there are markings that are consistent with the stylette being inserted while the blade was still being operated.H6: additional information suggest that fdm:b17, fdr:c20 and fdc:d14 no longer apply to this event.Medtronic is submitting this report to comply with fda reporting regulations under 21 cfr parts 4 and 803.This report is based upon information obtained by medtronic, which the company may not have been able to fully investigate or verify prior to the date the report was required by the fda.Medtronic has made reasonable efforts to obtain more complete information and has provided as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.In particular, this report does not constitute an admission by anyone that the product described in this report has any ¿defects¿ or has ¿malfunctioned¿.These words are included in the fda 3500a form and are fixed items for selection created by the fda to categorize the type of event solely for the purpose of regulatory reporting.Medtronic objects to the use of these words and others like them because of the lack of definition and the connotations implied by these terms.This statement should be included with any information or report disclosed to the public under the freedom of information act.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.A good faith effort will be made to obtain the applicable information relevant to the report.If information is provided in the future, a supplemental report will be issued.

• Brand Name: TRICUT STRAIGHT SHAFT 3.5MM 11CM LONG
• Type of Device: BUR, EAR, NOSE AND THROAT
• Manufacturer (Section D): MEDTRONIC XOMED INC.; 6743 southpoint dr n; jacksonville FL 32216
• MDR Report Key: 11831989
• MDR Text Key: 250855431
• Report Number: 1045254-2021-00245
• Device Sequence Number: 1
• Product Code: EQJ
• UDI-Device Identifier: 00681490047364
• UDI-Public: 00681490047364
• Combination Product (y/n): N
• PMA/PMN Number: EXEMPT
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,foreig
• Type of Report: Initial,Followup
• Report Date: 09/27/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 05/17/2021
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 1883504
• Device Catalogue Number: 1883504
• Device Lot Number: 0220216078
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 08/24/2021
• Date Manufacturer Received: 09/01/2021
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1