MAUDE Adverse Event Report: C.R. BARD, INC. (COVINGTON) -1018233 ENDOBEAM¿ HOLMIUM LASER FIBER

Catalog Number	SU0200
Health Effect - Clinical Code	No Code Available (3191)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The investigation is still in progress.Once the investigation is complete a supplemental report will be filed.The information provided by bard represents all of the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bard.
Event or Problem Description
It was reported that an additional used laser fiber sample was received with a sample for a separate complaint.The laser fiber was received with a broken tip.
Additional Manufacturer Narrative
Upon further review and additional information, bard medical has determined that this mdr was initially reported in error as this event is not reportable.
Event or Problem Description
It was reported that an additional used laser fiber sample was received with a sample for a separate complaint.The laser fiber was received with a broken tip.

• Brand Name: ENDOBEAM¿ HOLMIUM LASER FIBER
• Common Device Name: LASER FIBER
• Manufacturer (Section D): C.R. BARD, INC. (COVINGTON) -1018233; 8195 industrial blvd; covington GA 30014
• MDR Report Key: 6585498
• Report Number: 1018233-2017-02612
• Device Sequence Number: 767615
• Product Code: GEX
• UDI-Device Identifier: 00801741122194
• UDI-Public: (01)00801741122194(10)BMBNLP04
• Combination Product (Y/N): N
• Initial Reporter State: WI
• Initial Reporter Country: US
• PMA/510(K) Number: K120926
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: consumer,other
• Initial Reporter Occupation: Nurse
• Type of Report: Initial,Followup
• Report Date (Section B): 07/14/2017

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 Number: SU0200
• Device Lot Number: BMBNLP04
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 05/01/2017
• Initial Date Received by Manufacturer: 05/01/2017
• Supplement Date Received by Manufacturer: 06/29/2017
• Initial Report FDA Received Date: 05/23/2017
• Supplement Report FDA Received Date: 07/14/2017
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1