MAUDE Adverse Event Report: PAJUNK GMBH MEDIZINTECHNOLOGIE SPROTTE; SPINAL REGIONAL BLOCK ANAESTHESIA CONDUCTION NEEDLE

Model Number	121251-27A
Medical Device Problem Codes	Break (1069); Crack (1135); Fracture (1260); Inadequacy of Device Shape and/or Size (1583); Patient-Device Incompatibility (2682)
Health Effect - Clinical Codes	Pain (1994); Inadequate Pain Relief (2388); Foreign Body In Patient (2687)
Date of Event	09/30/2016
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Event took place in the (b)(6) and has been reported through (b)(4) distribution subsidiary pajunk medical (b)(4).Currently the data is poor and the device has not been sent back/ analysed.As soon as further data will be available a follow up report will be sent in to the agency.
Event or Problem Description
(b)(4).Summarizing tentative translation from initial reporter's narrative: needle broke within patient upon spinal anaesthesia.Neurological evaluation: leave fragment with patient.
Additional Manufacturer Narrative
Based on risk assessment and clinical evaluation file is considered as closed.
Event or Problem Description
(b)(4).Summarizing tentative translation from initial reporter´s narrative: needle broke within patient upon spinal anaesthesia.Neurological evaluation: leave fragment with patient.Patient is quite voluminous.Difficult approach.

• Brand Name: SPROTTE
• Common Device Name: SPINAL REGIONAL BLOCK ANAESTHESIA CONDUCTION NEEDLE
• Manufacturer (Section D): PAJUNK GMBH MEDIZINTECHNOLOGIE; karl-hall-str. 1; geisingen, baden-wuerttemberg 78187 ; GM 78187
• MDR Report Key: 6059529
• Report Number: 9611612-2016-00140
• Device Sequence Number: 19048415
• Product Code: BSP
• UDI-Device Identifier: 14048223022808
• UDI-Public: 14048223022808
• Combination Product (Y/N): N
• Initial Reporter Country: NL
• PMA/510(K) Number: K911202
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: distributor
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 11/28/2016

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?: Yes
• Operator of Device: Physician
• Device Expiration Date: 03/01/2021
• Device Model Number: 121251-27A
• Device Catalogue Number: 121251-27A
• Device Lot Number: 1152
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 10/10/2016
• Type of Report(Section G): FDA Requested
• Initial Date Received by Manufacturer: 10/04/2016
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 10/27/2016
• Supplement Report FDA Received Date: 11/28/2016
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Other; Required Intervention
• Patient Weight: 105