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H11: internal complaint reference: (b)(4).H3, h6: the reported device was received for evaluation.A visual inspection revealed the returned instrument shows no manufacturing abnormalities.Product was out of the original packaging.No packaging returned.The tip is worn from use.The electrode is missing from the tip, only stands remain in the tip spacer.The wand cannot be tested due to the damaged electrode.The resistance measured at 0.90 kilo ohms.A review of device records showed there were no indications to suggest that the product did not meet manufacturing specification upon release for distribution.A complaint history review found similar reported events.A risk management review found that the reported failure and/or harm was documented appropriately, and there were no indications to suggest the anticipated risk is not adequate.A definitive root cause for the reported issue could not be determined.Factors that could have contributed to the failure include procedural variance, or deviations from established protocols, increasing risks and leading to unintended consequences ((1) using the wand above default output settings, thus causing the electrodes to become eroded extensively.2) pressing the tip against hard or bony surfaces)).Based on this investigation, the need for corrective action is not indicated.
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It was reported that, during an unknown procedure, a super multivac wand had an electrode ablation situation.The procedure was resumed, an equivalent s+n back-up.It is unknown if there was a surgical delay.No further complications were reported.
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