MAUDE Adverse Event Report: COVIDIEN GENERATOR RADIOFREQUENCY; ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES

Catalog Number	RFG3
Medical Device Problem Code	Device Operates Differently Than Expected (2913)
Health Effect - Clinical Code	Thrombus (2101)
Date of Event	06/07/2017
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Manufacturer provided the unit history report for this device.A review of the unit history report from the manufacturer showed the generator was able to pass all testing prior to initial release.Unit functionally performed as expected however, the plastic portion of the catheter port was peeling off inside and the power switch needed to be re-aligned.During rf treatment, the closurerfg radiofrequency generator monitors the catheter¿s parameters (temperature, impedance, and rf power).Should one of these measurements be too high or too low, the closurerfg generator may stop rf treatment, sound an alarm, and/or display an alarm message.The therapy output data was overwritten by the service technician at the manufacturers site before it could be extracted for analysis.This has prevented analysis of the output data to determine if there were any unusual therapy behaviours contributing to these observations.If information is provided in the future, a supplemental report will be issued.
Event or Problem Description
Patient had treatment of left leg using a closurefast catheter along with an rfg3 radiofrequency generator.The lesion was a distance of 3 cm from the sfj.The diameter pre rfa was 10 mm sfj, 12 mm prox thigh, 6.6 mm mid-thigh.A total of 55 cm was treated.Patient developed endothermal heat induced thrombosis (ehit) - class 1 - described by the physician as 'loosely attached in gsv not extending'.Patient was treated with either lovenox and/or xyralta.Patient reported to be fine.

• Brand Name: GENERATOR RADIOFREQUENCY
• Common Device Name: ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES
• Manufacturer (Section D): COVIDIEN; 4600 nathan lane north; plymouth MN 55442
• MDR Report Key: 7285614
• Report Number: 2183870-2018-00100
• Device Sequence Number: 1823348
• Product Code: GEI
• UDI-Device Identifier: 10884521196544
• UDI-Public: 10884521196544
• Combination Product (Y/N): N
• Initial Reporter State: IA
• Initial Reporter Country: US
• PMA/510(K) Number: K141858
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Physician
• Type of Report: Initial
• Report Date (Section B): 02/21/2018

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?: No
• Operator of Device: Health Professional
• Device Catalogue Number: RFG3
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 08/15/2017
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 01/23/2018
• Initial Report FDA Received Date: 02/21/2018
• 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: Required Intervention