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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ETHICON ENDO-SURGERY, LLC. HARMONIC SCALPEL HAND PIECE; INSTRUMENT, ULTRASONIC SURGICAL

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ETHICON ENDO-SURGERY, LLC. HARMONIC SCALPEL HAND PIECE; INSTRUMENT, ULTRASONIC SURGICAL Back to Search Results
Catalog Number HP054
Medical Device Problem Code Material Integrity Problem (2978)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 01/01/2025
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
(b)(4).Date sent: 7/21/2025.B3: event year only reported: 2025.D4 batch #: x9680m.Additional information was requested and the following was obtained: did the patient experience any adverse consequences due to this issue? there were no consequences for the patient, except a delay in management in the block and stress generated at the level of the operating team.Investigation summary: the handpiece hp054 was received disassembled, the nose cone was returned apart cracked.No functional testing could be done due to the condition of the returned device.No damaged at the cable nor the insulation was noted as reported.The end cap was disassembled to inspect remaining components.The moisture indicator was positive and the internal wires disconnected.¿positive moisture indicator¿ describes a condition where water enters the handpiece cavity during the steam sterilization process due to the damaged nose cone.Analysis was unable to determine the exact root cause that lead to crack in the hand piece nosecone.The manufacturing records were reviewed and the manufacturing/packaging criteria were met prior to the release of this batch.It is probable that the ingress of moisture affected handpiece functionality.A manufacturing record evaluation was performed for the finished device batch x9680m, and no non-conformances were identified.This report is being submitted pursuant to the provisions of 21 cfr, part 803.This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by ethicon, or its employees that the report constitutes an admission that the product, ethicon, or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.
 
Event or Problem Description
It was reported that during an unknown procedure there was use of a new handpiece, which was dysfunctional, and therefore switch to a single-use harmonic pliers with integrated handpiece so that the block can continue.
 
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Brand Name
HARMONIC SCALPEL HAND PIECE
Common Device Name
INSTRUMENT, ULTRASONIC SURGICAL
Manufacturer (Section D)
ETHICON ENDO-SURGERY, LLC.
475 calle c
guaynabo 00969
*  00969
Manufacturer (Section G)
ETHICON ENDO-SURGERY, LLC.
475 calle c
guaynabo 00969
*   00969
Manufacturer Contact
orla o'mahony
475 calle c
guaynabo 
*  
3035526892
MDR Report Key22559645
Report Number3005075853-2025-05723
Device Sequence Number9700286
Product Code LFL
UDI-Device Identifier20705036002144
UDI-Public(01)20705036002144
Combination Product (Y/N)N
Initial Reporter CountryFR
PMA/510(K) Number
K002906
Number of Events Summarized1
Summary Report (Y/N)N
Serviced by Third Party (Y/N)Unknown
Reporter Type Manufacturer
Report Source Foreign,Health Professional
Initial Reporter Occupation Other
Type of Report Initial
Report Date (Section B) 07/21/2025
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 Catalogue NumberHP054
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer07/07/2025
Type of Report(Section G)Initial
Initial Date Received by Manufacturer 07/14/2025
Initial Report FDA Received Date07/21/2025
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured11/10/2022
Is This a Single-Use Device that was
Reprocessed and Reused on a Patient? (Y/N)
No
Usage of Device Reuse
Patient Sequence Number1
Concomitant Medical Products
and Therapy/Usage Dates
GENERATOR.
Patient SexUnknown
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