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Adverse Event Report

EES-SMITHFIELD HARMONIC SCALPEL LAPAROSONIC COAGULATING SHEARS   back to search results
Catalog Number LCS15
Event Date 02/11/1998
Event Type  Malfunction   Patient Outcome  Other;
Manufacturer Narrative

The product complaint analysis team has completed its investigation of the device wjich was returned. The results of the investigation conducted by the appropriate enginneers and technicians are listed below. Visual inspection and results: evidence of debris in threaded ares, no; evidence of non-functionality, no; external damage to lcs/cs housing, no; external physical damage, no. Functional tests and results: blade not energize/cut correctly, no; lcs/cs jaw not open/close correctly, no; lcs/cs not rotate/latch correctly, no. Based on the information received and the visual and functional results, no conclusion could be reached as to what may have caused the reported incident. The device was received in good condition. The device was tested and was found to be functional. There were no anamolies noted with the alignment of the blade and tissue pad. The reported incident could not be recreated. Manufacturing and enginneering have been notified of the reported incident.

 
Event Description

It was reported during a laparoscopic nissen fundoplication the staff couldn't get the lcs to properly align. The blade and the tissue pad would not come together properly. Another lcs was opened to complete the case. The alignment pin was in the grip housing unit, but has since vanished. They did have it inserted when introducing the blade. There was no consequence to the patient.

 
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Brand NameHARMONIC SCALPEL LAPAROSONIC COAGULATING SHEARS
Type of DeviceCOAGULATING SHEAR
Baseline Brand NameHARMONIS SCALPEL LAPAROSONIC COAGULATING SHEARS
Baseline Generic NameELECTRO-SURGERY ACCESSORIES
Baseline Catalogue NumberLCS15
Baseline Model NumberLCS15
Baseline Device FamilyELECTRO-SURGERY ACCESSORIES - ENDOS
Baseline Device 510(K) NumberK904993
Baseline Device PMA Number
Baseline Shelf Life Information Yes
Baseline Preamendment? No
Transitional? No
510(K) Exempt? No
Shelf Life(Months)60
Date First Marketed01/25/1991
Manufacturer (Section F)
EES-SMITHFIELD
25 thurber blvd
smithfield RI 02917
Manufacturer (Section D)
EES-SMITHFIELD
25 thurber blvd
smithfield RI 02917
Manufacturer (Section G)
ETHICON ENDO-SURGERY, INC.
4545 creek rd.
cincinnati OH 45242 2839
Manufacturer Contact
tom bosticco
4545 creek rd
cincinnati , OH 45242
(513) 337 -8935
Device Event Key151752
MDR Report Key155790
Event Key146335
Report Number1527736-1998-00691
Device Sequence Number1
Product CodeKNS
Report Source Manufacturer
Source Type Company Representative
Reporter Occupation Other
Remedial Action Other
Type of Report Initial,Followup
Report Date 02/11/1998
1 Device Was Involved in the Event
1 Patient Was Involved in the Event
Date FDA Received03/11/1998
Is This An Adverse Event Report? No
Is This A Product Problem Report? Yes
Device Operator Health Professional
Device EXPIRATION Date11/01/2002
Device Catalogue NumberLCS15
Device LOT NumberK48T35
OTHER Device ID NumberBATCH # K48R3H
Was Device Available For Evaluation? Yes
Is The Reporter A Health Professional? No
Was the Report Sent to FDA? No
Device Agena
Event Location Not Applicable
Date Manufacturer Received02/11/1998
Was Device Evaluated By Manufacturer? Yes
Date Device Manufactured12/01/1997
Is The Device Single Use? Yes
Is the Device an Implant? No
Is this an Explanted Device?
Type of Device Usage Unkown

Database last updated on February 28, 2009

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