MAUDE Adverse Event Report: DEVICOR MEDICAL PRODUCTS, INC. MAMMOTOME REVOLVE STEREOTACTIC PROB; BIOPSY INSTRUMENT

Model Number	MST0809
Medical Device Problem Code	Unsealed Device Packaging (1444)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	02/01/2019
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The revolve stereotactic probe is a sterile, single-patient use device that may be used with imaging guidance to excise a tissue sample for diagnosis.The device has not been returned for investigation.No adverse event occurred with the usage of this product.Due to the open package that can potentially affect sterility, we consider this event to be a product malfunction that if it were to recur, has the potential to cause or contribute to a serious injury.
Event or Problem Description
Devicor medical products, inc.Received a report from our affiliate devicor medical france, stating before the procedure the disposable box was already open and the device not sterile.No patient involvement.This has been documented in our system as record # (b)(4).

• Brand Name: MAMMOTOME REVOLVE STEREOTACTIC PROB
• Common Device Name: BIOPSY INSTRUMENT
• Manufacturer (Section D): DEVICOR MEDICAL PRODUCTS, INC.; 300 e. business way; fifth floor; cincinnati OH 45241
• MDR Report Key: 8380151
• Report Number: 3008492462-2019-00010
• Device Sequence Number: 16477035
• Product Code: KNW
• UDI-Device Identifier: 00841911100713
• UDI-Public: (01)00841911100713(17)210305(10)F11808461D
• Combination Product (Y/N): N
• PMA/510(K) Number: K152989
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 02/28/2019

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: 03/05/2021
• Device Model Number: MST0809
• Device Catalogue Number: MST0809
• Device Lot Number: F11808461D
• Was Device Available for Evaluation?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/01/2019
• Initial Report FDA Received Date: 02/28/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1