MAUDE Adverse Event Report: COVIDIEN LP LCD HANDSWITCH STERIL CS/10; ES ACCESSORY

Model Number	E2750
Medical Device Problem Code	Device Remains Activated (1525)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	11/30/2016
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(4).Date of initial report: 12/15/2016.To date, the incident sample has not been received for evaluation.If the sample is received, or if additional information pertinent to the incident is obtained, a follow-up report will be submitted.
Event or Problem Description
The customer reported that the activation button keeps sticking on the handset.There was no injury to the patient.The issue was solved by using a new device.
Additional Manufacturer Narrative
Covidien reference#: (b)(4).Date of initial report: 12/15/2016.Date of follow-up report: 01/20/2017.Per engineering investigation, the ¿latch on¿ condition was caused by interference between the rocker component and the rocker window in which it moves.The width of the rocker was found to be larger than the width of the rocker window.The width of the rocker window is formed by the ultrasonic welding of the two body housing components.Corrective action is being issued.

• Brand Name: LCD HANDSWITCH STERIL CS/10
• Common Device Name: ES ACCESSORY
• Manufacturer (Section D): COVIDIEN LP; 5920 longbow drive; boulder CO 80301
• MDR Report Key: 6178956
• Report Number: 1717344-2016-01171
• Device Sequence Number: 929762
• Product Code: GEI
• UDI-Device Identifier: 10884524000435
• UDI-Public: 10884524000435
• Combination Product (Y/N): N
• Initial Reporter Country: UK
• PMA/510(K) Number: K964175
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: foreign,user facility
• Initial Reporter Occupation: Other
• Remedial Action: Recall
• Type of Report: Initial,Followup
• Report Date (Section B): 12/05/2016

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 Expiration Date: 04/01/2021
• Device Model Number: E2750
• Device Catalogue Number: E2750
• Device Lot Number: 60520104X
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 02/28/2017
• Type of Report(Section G): FDA Requested
• Initial Date Received by Manufacturer: 12/05/2016
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 12/15/2016
• Supplement Report FDA Received Date: 03/06/2017
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1