MAUDE Adverse Event Report: SMITH & NEPHEW, INC. CHISEL MICRO VULCAN HOOK INTEGRATED; ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES

Model Number	7209643
Medical Device Problem Code	Activation Problem (4042)
Health Effect - Clinical Code	No Known Impact Or Consequence To Patient (2692)
Date of Event	02/11/2020
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(6).
Event or Problem Description
It was reported that, during a procedure, the vulcan hook chisel micro did not perform the function of coagulation and cutting.The controller was changed; however, the problem persisted.The procedure was completed using a competitor device.No significant delay or patient injury was reported.All available information has been disclosed.If additional information should become available, a supplemental report will be submitted accordingly.
Additional Manufacturer Narrative
H3, h6: the device, which was used in a procedure, was not returned for evaluation.Visual inspection and functional testing could not be performed.A relationship, if any, between the device and the reported incident could not be confirmed.A review of the manufacturing records found that there was no evidence that the product didn¿t meet specifications at the time of manufacture.A complaint history review found no other related failures.Factors that are known to contribute to the alleged fault/failure may include mishandling during shipping, connection issue, or a component failure.If the product is returned in the future the complaint can be reopened and evaluated.No further investigation is required.

• Brand Name: CHISEL MICRO VULCAN HOOK INTEGRATED
• Common Device Name: ELECTROSURGICAL, CUTTING & COAGULATION & ACCESSORIES
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 150 minuteman road; andover MA 01810
• MDR Report Key: 9789784
• Report Number: 3003604053-2020-00010
• Device Sequence Number: 19551790
• Product Code: GEI
• UDI-Device Identifier: 03596010470485
• UDI-Public: 03596010470485
• Combination Product (Y/N): N
• Initial Reporter Country: MX
• PMA/510(K) Number: K003893
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: foreign,health professional,o
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 04/08/2020

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: 12/03/2021
• Device Model Number: 7209643
• Device Catalogue Number: 7209643
• Device Lot Number: 4594728
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 02/11/2020
• Supplement Date Received by Manufacturer: 04/03/2020
• Initial Report FDA Received Date: 03/04/2020
• Supplement Report FDA Received Date: 04/08/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Age: 30 YR