MAUDE Adverse Event Report: OLYMPUS WINTER & IBE GMBH ELECTROSURGICAL GENERATOR "CELON ELITE ESG-200", B TYPE; ELECTROSURGICAL SYSTEM GENERATOR

Model Number	WA90002A
Health Effect - Clinical Code	Necrosis (1971)
Date of Event	07/22/2022
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported by an olympus territory manager, the patient's turbinate was being overtreated during a submucosal resection (smr) procedure using the electrosurgical generator.It was reported the output from the handpiece was high and the tissue experienced necrosis.The customer was advised to turn down the output of the device.The procedure was completed without delay, and there were no reports of a device malfunction.It was reported the device was inspected prior to the procedure, and no anomalies were found.Follow-up with the physician indicated the necrosis issue was noted at the first follow-up appointment after the procedure.The physician reported three (3) patients experienced necrosis of the head and mid-body of the inferior turbinate.There were allegedly no clinical symptoms, but the physician had a concern for long term empty nose syndrome.The tissue necrosis was treated with debridement and observation.The physician reported 2 devices were involved with the event: wa90002a, serial (b)(4), and wb990310, lot 1000084723.The 3 patients involved and the corresponding devices are as follows: case with patient identifier (b)(6) reports 75 year old asian male, wa90002a, case with patient identifier (b)(6) reports 75 year old asian male, wb990310, case with patient identifier (b)(6) reports 49 year old asian male, wa90002a, case with patient identifier (b)(6) reports 49 year old asian male, wb990310, case with patient identifier (b)(6) reports 52 year old white female, wa90002a, case with patient identifier (b)(6) reports 52 year old white female, wb990310.

• Brand Name: ELECTROSURGICAL GENERATOR "CELON ELITE ESG-200", B TYPE
• Common Device Name: ELECTROSURGICAL SYSTEM GENERATOR
• Manufacturer (Section D): OLYMPUS WINTER & IBE GMBH; kuehnstrasse 61; hamburg 22045 ; GM 22045
• MDR Report Key: 15414502
• Report Number: 2429304-2022-00055
• Device Sequence Number: 20487838
• Product Code: GEI
• UDI-Device Identifier: 04042761082969
• UDI-Public: 04042761082969
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 09/13/2022
• Report Date (Section F): 08/24/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Health Professional
• Device Model Number: WA90002A
• Device Catalogue Number: WA90002A
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: Yes
• Distributor Facility Aware Date: 08/24/2022
• Device Age: 7 MO
• Date Report to Manufacturer: 08/24/2022
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 09/13/2022
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: WB990310, LOT 1000084723
• Outcome Attributed to Adverse Event: Other
• Patient Age: 52 YR
• Patient Sex: Female
• Patient Race: White