MAUDE Adverse Event Report: DEVICOR MEDICAL PRODUCTS INC 8G MAMMOTOME REVOLVE STEREOTACTIC PROBE; BIOPSY SYSTEM

Model Number	MST0809
Medical Device Problem Code	Fluid/Blood Leak (1250)
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	10/08/2019
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The mammotome revolve dual vacuum assisted biopsy system is intended to obtain tissue samples from the breast or axillary nodes for diagnostic analysis of breast abnormalities.The device has not been returned for evaluation, which prevents a full investigation and analysis of the root cause at this time.However, this failure mode has been reviewed by our medical advisor and identified in the risk management file for performance expectations.The device is intended to be used by a trained professional who is familiar with precautions related to blood borne pathogen exposure when completing a biopsy procedure.However, ejection with velocity is not expected by the user and has greater chance to harm than fluid egression including, but not limited to, the fluid entering mucous membranes.The device is not meeting its intended performance specification and claims and is considered to have malfunctioned.The patient or user may be exposed to biological hazards resulting in infection or cross-contamination.Although no serious injuries have occured, this failure mode has been evaluated by our medical advisor and based on potential for cross contamination or infection due to possible exposure to body fluids, it has been determined to be a reportable malfunction.Thus, pursuant to 21 cfr 803, we are submitted this medwatch report.
Event or Problem Description
It was reported by rep during procedure during biopsy, rad went into inject additional lido and the lido shot out of the back of the specimen collection chamber.As a result, a tissue sample as hanging out of the back of the collection chamber and both the rad and tech had gotten sprayed with fluid.They were able to complete the biopsy but wanted to make note of this occurrence.The procedure was completed with the original device.No patient complications.

• Brand Name: 8G MAMMOTOME REVOLVE STEREOTACTIC PROBE
• Common Device Name: BIOPSY SYSTEM
• Manufacturer (Section D): DEVICOR MEDICAL PRODUCTS INC; 300 e business way; fifth floor; cincinnati OH 45241
• MDR Report Key: 9269834
• Report Number: 3008492462-2019-00048
• Device Sequence Number: 16712286
• Product Code: KNW
• UDI-Device Identifier: 10841911100710
• UDI-Public: (01)10841911100710(17)220722(10)F11929548D
• Combination Product (Y/N): N
• Initial Reporter State: IN
• Initial Reporter Country: US
• PMA/510(K) Number: K152989
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 11/01/2019

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: No Information
• Device Expiration Date: 07/22/2022
• Device Model Number: MST0809
• Device Catalogue Number: MST0809
• Device Lot Number: F11929548D
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 10/10/2019
• Initial Report FDA Received Date: 11/02/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1