MAUDE Adverse Event Report: CONMED CORPORATION ELECTRODE FLAT BLADE 4IN, SMOKE EVAC; ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES

Model Number	138112
Medical Device Problem Code	Delivered as Unsterile Product (1421)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Investigation of the customer's complaint of an insufficient heat seal leading to a breach in sterility has confirmed the reported issue.Conmed received one 138112 unopened in original packaging, the reported catalog and lot numbers were verified.A visual inspection found the device encroached into the seal on the packaging.A functional inspection was then performed and the devices were dye leak tested per policy.The dye leak test indicated that the packaging had an insufficient heat seal.Dye leaked out into the gap on the seal caused by encroaching device.The manufacturing documents from the device history record have been reviewed and found no abnormalities that would contribute to this issue.A two-year lot history review was conducted and found no other similar events reported for this lot number.(b)(4).The instructions for use (ifu) provides the user with information regarding proper care and use of this device.Also per the ifu the user is advised that these devices should never be used when: there is visible evidence of damage to the exterior of the device such as cracked or damaged plastic; these devices fail the inspection described herein.This issue will continue to be monitored through the complaint system to assure patient safety.
Event or Problem Description
During incoming inspection, the distributor rejected this device, electrode flat blade 4in, smoke evac, catalog # 138112, lot 201908191, for a possible breach of sterility due to an insufficient heatseal.There was no contact with any patient as this was found during incoming inspection in japan.The completion of the device evaluation confirmed an insufficient heatseal.Due to the breach in sterility, this report is being raised as a malfunction with potential for injury upon reoccurrence.

• Brand Name: ELECTRODE FLAT BLADE 4IN, SMOKE EVAC
• Common Device Name: ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES
• Manufacturer (Section D): CONMED CORPORATION; 525 french road; utica NY 13502 5994
• MDR Report Key: 11887257
• Report Number: 1320894-2021-00233
• Device Sequence Number: 17071165
• Product Code: GEI
• UDI-Device Identifier: 30653405003469
• UDI-Public: (01)30653405003469(17)240817(10)201908191
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• PMA/510(K) Number: K943542
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: distributor,foreign
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 05/26/2021

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: No Information
• Device Expiration Date: 08/17/2024
• Device Model Number: 138112
• Device Catalogue Number: 138112
• Device Lot Number: 201908191
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 04/23/2021
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 04/28/2021
• Initial Report FDA Received Date: 05/26/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1