SPROTTE SPINAL NEEDLE ADVERSE REPORTS

 

 

1.

BRAND NAME

SPROTTE SPINAL TRAY

TYPE OF DEVICE

SPINAL NEEDLE

MANUFACTURER (Section F)

B BRAUN MEDICAL, INC

824 TWELFTH AVE

PO BOX 4027

BETHLEHEM PA 18018 0027

 

MANUFACTURER (Section D)

B BRAUN MEDICAL, INC

824 TWELFTH AVE

PO BOX 4027

BETHLEHEM PA 18018 0027

 

DEVICE EVENT KEY

404417

MDR REPORT KEY

415379

EVENT KEY

392807

REPORT NUMBER

415379

DEVICE SEQUENCE NUMBER

1

PRODUCT CODE

BSP

REPORT SOURCE

USER FACILITY

TYPE OF REPORT

INITIAL

REPORT DATE

08/30/2002

1 DEVICE WAS INVOLVED IN THE EVENT

 

1 PATIENT WAS INVOLVED IN THE EVENT

 

DATE FDA RECEIVED

09/04/2002

IS THIS AN ADVERSE EVENT REPORT?

YES

IS THIS A PRODUCT PROBLEM REPORT?

YES

DEVICE OPERATOR

HEALTH PROFESSIONAL

DEVICE EXPIRATION DATE

11/01/2003

DEVICE MODEL NUMBER

SP25BK

DEVICE CATALOGUE NUMBER

333750

DEVICE LOT NUMBER

60315313 200 3-11

WAS DEVICE AVAILABLE FOR EVALUATION?

DEVICE NOT RETURNED TO MANUFACTURER

DATE RETURNED TO MANUFACTURER

08/30/2002

IS THE REPORTER A HEALTH PROFESSIONAL?

YES

WAS THE REPORT SENT TO FDA?

YES

DATE REPORT TO FDA

08/12/2002

DISTRIBUTOR FACILITY AWARE DATE

07/17/2002

EVENT LOCATION

HOSPITAL

DATE REPORT TO MANUFACTURER

07/17/2002

PATIENT OUTCOME

REQUIRED INTERVENTION 

 

ADVERSE EVENT OR PRODUCT PROBLEM DESCRIPTION

REPORT DATE: 08/30/2002  MDR TEXT KEY: 1442849 Patient Sequence Number: 1

PT WAS UNDERGOING REPAIR OF INCISIONAL HERNIA UNDER SPINAL BLOCK AT L4-5. BETADINE PREP, 1% LIDO INTRODUCER NEEDLE PLACED. 25G SPROTTE NEEDLE PLACED WITHOUT CSF. WHEN NEEDLE WAS WITHDRAWN, HALF OF NEEDLE WAS LEFT IN PT. RETAINED PORTION OF NEEDLE WAS REMOVED WITH FLUOROSCOPY.

 

2.

BRAND NAME

SPROTTE SPINAL NEEDLE TRAY

TYPE OF DEVICE

SPINAL NEEDLE TRAY

BASELINE BRAND NAME

SPROTTE SPINAL NEEDLE TRAY

BASELINE GENERIC NAME

SPINAL NEEDLE KIT

BASELINE CATALOGUE NUMBER

333750

BASELINE MODEL NUMBER

SP25BK

BASELINE DEVICE FAMILY

SPINAL NEEDLE KIT

BASELINE DEVICE 510(K) NUMBER

K932569

BASELINE SHELF LIFE INFORMATION

YES

IS BASELINE PMA NUMBER PROVIDED?</< TH>

NO

BASELINE PREAMENDMENT?

NO

TRANSITIONAL?

NO

510(K) EXEMPT?

NO

SHELF LIFE(Months)

12

DATE FIRST MARKETED

01/26/1994

MANUFACTURER (Section F)

B. BRAUN MEDICAL, INC.

901 MARCON BLVD.

ALLENTOWN PA 18103

 

MANUFACTURER (Section D)

B. BRAUN MEDICAL, INC.

901 MARCON BLVD.

ALLENTOWN PA 18103

 

MANUFACTURER CONTACT

ART MORSE

901 MARCON BLVD.

ALLENTOWN , PA 18103

(610) 266 -0500

 

DEVICE EVENT KEY

400665

MDR REPORT KEY

411652

EVENT KEY

389224

REPORT NUMBER

2523676-2002-00045

DEVICE SEQUENCE NUMBER

1

PRODUCT CODE

CAZ

REPORT SOURCE

MANUFACTURER

SOURCE TYPE

HEALTH PROFESSIONAL

REMEDIAL ACTION

OTHER

EVENT TYPE

INJURY

TYPE OF REPORT

INITIAL

REPORT DATE

08/09/2002

1 DEVICE WAS INVOLVED IN THE EVENT

 

1 PATIENT WAS INVOLVED IN THE EVENT

 

DATE FDA RECEIVED

08/19/2002

IS THIS AN ADVERSE EVENT REPORT?

YES

IS THIS A PRODUCT PROBLEM REPORT?

NO

DEVICE OPERATOR

HEALTH PROFESSIONAL

DEVICE EXPIRATION DATE

11/30/2003

DEVICE MODEL NUMBER

SP25BK

DEVICE CATALOGUE NUMBER

333750

WAS DEVICE AVAILABLE FOR EVALUATION?

YES

IS THE REPORTER A HEALTH PROFESSIONAL?

YES

WAS THE REPORT SENT TO FDA?

NO

DISTRIBUTOR FACILITY AWARE DATE

07/17/2002

DEVICE AGE

UNKNOWN

EVENT LOCATION

HOSPITAL

DATE MANUFACTURER RECEIVED

07/17/2002

WAS DEVICE EVALUATED BY MANUFACTURER?

DEVICE NOT RETURNED TO MANUFACTURER

IS THE DEVICE SINGLE USE?

YES

TYPE OF DEVICE USAGE

UNKNOWN

PATIENT OUTCOME

REQUIRED INTERVENTION 

 

ADDITIONAL MANUFACTURER NARRATIVE

REPORT DATE: 08/09/2002  MDR TEXT KEY: 1430300 

THE ACTUAL SAMPLE HAS NOT YET BEEN RETURNED TO THE MANUFACTURER FOR EVALUATION. BASED ON THE INFORMATION PROVIDED, NO SPECIFIC CONCLUSIONS CAN BE DRAWN. IF APPLICABLE, A FOLLOW UP REPORT WILL BE FILED WHEN THE SAMPLE IS RETURNED.

 

ADVERSE EVENT OR PRODUCT PROBLEM DESCRIPTION

REPORT DATE: 08/09/2002  MDR TEXT KEY: 1430297 Patient Sequence Number: 1

USER FACILITY REPORTS THE FOLLOWING: OBESE PATIENT UNDERGOING UMBILICAL REPAIR. SPINAL NEEDLE WAS INTRODUCED THROUGH INTRODUCER AND DOCTOR DETERMINED HE HAD NOT ENTERED SUBARACHNOID SPACE AND DECIDED TO WITHDRAW NEEDLE TO REPOSITION. DURING WITHDRAWAL OF SPINAL NEEDLE, NEEDLE BROKE APPROXIMATELY IN HALF, DISTAL HALF REMAINING IN PATIENT. THE FRAGMENT WAS SURGICALLY REMOVED. ACCORDING TO DOCTOR, THE PATIENT IS DOING WELL.

 

3.

BRAND NAME

SPROTTE SPINAL NEEDLE TRAY

TYPE OF DEVICE

ANESTHESIA AGENT - SPINAL NEEDLE TRAY

MANUFACTURER (Section D)

B. BRAUN MEDICAL, INC.

BETHLEHEM PA 18018

 

DEVICE EVENT KEY

391600

MDR REPORT KEY

402591

EVENT KEY

380478

REPORT NUMBER

402591

DEVICE SEQUENCE NUMBER

1

PRODUCT CODE

CAZ

REPORT SOURCE

VOLUNTARY

REPORT DATE

06/20/2002

1 DEVICE WAS INVOLVED IN THE EVENT

 

1 PATIENT WAS INVOLVED IN THE EVENT

 

DATE FDA RECEIVED

06/26/2002

IS THIS AN ADVERSE EVENT REPORT?

NO

IS THIS A PRODUCT PROBLEM REPORT?

YES

DEVICE OPERATOR

HEALTH PROFESSIONAL

DEVICE EXPIRATION DATE

11/01/2003

DEVICE LOT NUMBER

60306444

WAS DEVICE AVAILABLE FOR EVALUATION?

NO ANSWER PROVIDED

PATIENT OUTCOME

OTHER 

 

ADVERSE EVENT OR PRODUCT PROBLEM DESCRIPTION

REPORT DATE: 06/20/2002  MDR TEXT KEY: 1398498 Patient Sequence Number: 1

PT SCHEDULED TO UNDERGO TOTAL KNEE REPLACEMENT WITH SPINAL ANESTHESIA. GOOD SPINAL TAP, NO RESULTS WITH ANESTHETIC AGENT. PT CONVERTED TO GENERAL ANESTHESIA DUE TO FAILED SPINAL.

 

4.

BRAND NAME

SPROTTE

TYPE OF DEVICE

SPINAL NEEDLE

BASELINE BRAND NAME

SPROTTE

BASELINE GENERIC NAME

SPINAL NEEDLE

BASELINE CATALOGUE NUMBER

333769

BASELINE MODEL NUMBER

SP27123

BASELINE DEVICE FAMILY

SPINAL NEEDLE

BASELINE DEVICE 510(K) NUMBER

K932569

BASELINE SHELF LIFE INFORMATION

YES

IS BASELINE PMA NUMBER PROVIDED?</< TH>

NO

BASELINE PREAMENDMENT?

NO

TRANSITIONAL?

NO

510(K) EXEMPT?

NO

SHELF LIFE(Months)

12

DATE FIRST MARKETED

01/26/1994

MANUFACTURER (Section F)

B. BRAUN MEDICAL, INC.

901 MARCON BLVD.

ALLENTOWN PA 18103

 

MANUFACTURER (Section D)

B. BRAUN MEDICAL, INC.

901 MARCON BLVD.

ALLENTOWN PA 18103

 

MANUFACTURER CONTACT

KIKOO TEJWANI

901 MARCON BLVD.

ALLENTOWN , PA 18103

(610) 266 -0500

 

DEVICE EVENT KEY

351455

MDR REPORT KEY

362312

EVENT KEY

341566

REPORT NUMBER

2523676-2001-00055

DEVICE SEQUENCE NUMBER

1

PRODUCT CODE

BSP

REPORT SOURCE

MANUFACTURER

SOURCE TYPE

USER FACILITY

REMEDIAL ACTION

OTHER

EVENT TYPE

INJURY

TYPE OF REPORT

INITIAL

REPORT DATE

11/14/2001

1 DEVICE WAS INVOLVED IN THE EVENT

 

1 PATIENT WAS INVOLVED IN THE EVENT

 

DATE FDA RECEIVED

11/19/2001

IS THIS AN ADVERSE EVENT REPORT?

YES

IS THIS A PRODUCT PROBLEM REPORT?

NO

DEVICE OPERATOR

HEALTH PROFESSIONAL

DEVICE MODEL NUMBER

SP27123

DEVICE CATALOGUE NUMBER

333769

DEVICE LOT NUMBER

60083531

WAS DEVICE AVAILABLE FOR EVALUATION?

YES

IS THE REPORTER A HEALTH PROFESSIONAL?

YES

WAS THE REPORT SENT TO FDA?

NO

DISTRIBUTOR FACILITY AWARE DATE

10/19/2001

DEVICE AGE

1.5 YR

EVENT LOCATION

HOSPITAL

DATE MANUFACTURER RECEIVED

10/22/2001

WAS DEVICE EVALUATED BY MANUFACTURER?

YES

DATE DEVICE MANUFACTURED

03/01/2000

IS THE DEVICE SINGLE USE?

YES

TYPE OF DEVICE USAGE

INITIAL

PATIENT OUTCOME

OTHER 

 

ADVERSE EVENT OR PRODUCT PROBLEM DESCRIPTION

REPORT DATE: 11/14/2001  MDR TEXT KEY: 1258947 Patient Sequence Number: 1

THE USER FACILITY REPORTED THE FOLLOWING: "PERFORMING SPINAL ANESTHESIA ON A PT TWO ATTEMPTS AT ADVANCEMENT OF NEEDLE RESISTANCE WAS FELT. ON THIRD ATTEMPT TO ADVANCE NEEDLE, APPROX 1/2 INCH OF DISTAL END OF NEEDLE BROKE OFF. UNABLE TO REMOVE FRAGMENT IN PERI-SPINOUS MUSCLE. SCHEDULED PROCEDURE WAS COMPLETED WITHOUT FURTHER INCIDENT."

 

ADDITIONAL MANUFACTURER NARRATIVE

REPORT DATE: 11/19/2001  MDR TEXT KEY: 1258950 

ONE USED SPINAL NEEDLE WAS RETURNED FOR EVAL. APPROX 14MM OF THE UNSHEATHED NEEDLE WAS MISSING. THE NEEDLE LENGTH MEASURED 109MM (SPECIFICATION IS 123MM +/- 1MM). INFO PROVIDED BY THE USER FACILITY INDICATES THAT RESISTANCE WAS FELT DURING INSERTION IN PT. IN ADDITION THE APPEARANCE OF THE BREAK SUGGESTS THAT THE NEEDLE WAS BENT BEYOND ITS INTENDED DESIGN CAPABILITIES WHICH CAUSED IT TO BREAK. THERE WAS NO INDICATION THAT THIS OCCURRENCE WAS THE RESULT OF THE PRODUCT MALFUNCTION. NO FURTHER INFO IS AVAILABLE ON THE PT'S STATUS.

 

5.

BRAND NAME

SPINAL 24G SPROTTE

TYPE OF DEVICE

REGIONAL ANESTHESIA TRAY

BASELINE BRAND NAME

SPINAL 24G SPROTTE

BASELINE GENERIC NAME

REGIONAL ANESTHESIA TRAY

BASELINE CATALOGUE NUMBER

15858

MANUFACTURER (Section F)

ABBOTT LABORATORIES

P.O. DRAWER 1009

LAURINBURG NC 28352

 

MANUFACTURER (Section D)

ABBOTT LABORATORIES

P.O. DRAWER 1009

LAURINBURG NC 28352

 

MANUFACTURER (Section G)

ABBOTT LABORATORIES

P.O. DRAWER 1009

 

LAURINBURG NC 28352

 

MANUFACTURER CONTACT

FRANK POKROP, ASSOC DIRECTOR

200 ABBOTT PARK ROAD

DEPT 37K, AP30

ABBOTT PARK , IL 60064-6157

(847) 937 -8473

 

DEVICE EVENT KEY

329218

MDR REPORT KEY

339894

EVENT KEY

320010

REPORT NUMBER

1018381-2001-00050

DEVICE SEQUENCE NUMBER

1

PRODUCT CODE

CAZ

REPORT SOURCE

MANUFACTURER

SOURCE TYPE

HEALTH PROFESSIONAL

EVENT TYPE

INJURY

TYPE OF REPORT

INITIAL,FOLLOWUP

REPORT DATE

05/24/2001

1 DEVICE WAS INVOLVED IN THE EVENT

 

1 PATIENT WAS INVOLVED IN THE EVENT

 

DATE FDA RECEIVED

06/29/2001

IS THIS AN ADVERSE EVENT REPORT?

YES

IS THIS A PRODUCT PROBLEM REPORT?

NO

DEVICE OPERATOR

HEALTH PROFESSIONAL

DEVICE CATALOGUE NUMBER

15858

DEVICE LOT NUMBER

66-571-Z1

WAS DEVICE AVAILABLE FOR EVALUATION?

NO

IS THE REPORTER A HEALTH PROFESSIONAL?

YES

WAS THE REPORT SENT TO FDA?

NO

DATE MANUFACTURER RECEIVED

05/24/2001

WAS DEVICE EVALUATED BY MANUFACTURER?

NO

DATE DEVICE MANUFACTURED

06/01/2000

IS THE DEVICE SINGLE USE?

YES

TYPE OF DEVICE USAGE

INITIAL

PATIENT OUTCOME

REQUIRED INTERVENTION 

 

ADVERSE EVENT OR PRODUCT PROBLEM DESCRIPTION

REPORT DATE: 05/24/2001  MDR TEXT KEY: 1176126 Patient Sequence Number: 1

REPORT RECEIVED OF A SPINAL NEEDLE BREAK DURING A C-SECTION PROCEDURE. THE CUSTOMER REPORTS THAT THE PT WAS IN THE OPERATING ROOM FOR A C-SECTION "WHEN THE SPROTTE NEEDLE BROKE OFF." THE PT WAS REPORTED TO BE "DOING FINE." THERE WAS NO REPORT OF ANY ADVERSE PT EFFECT. MULTIPLE ATTEMPTS TO OBTAIN ADDITIONAL INFORMATION HAVE BEEN MADE, BUT NO FURTHER INFO WAS RECEIVED.

 

ADDITIONAL MANUFACTURER NARRATIVE

REPORT DATE: 06/29/2001  MDR TEXT KEY: 1176129 

THE DEVICE IS EXPECTED TO BE RETURNED FOR TESTING AND INVESTIGATION. IT HAS NOT YET BEEN RECEIVED. THIS REPORT REPRESENTS ALL THE INFO KNOWN BY THE RPTR UPON QUERY BY ABBOTT PERSONNEL.

 

ADDITIONAL MANUFACTURER NARRATIVE

REPORT DATE: 05/24/2001  MDR TEXT KEY: 1500411 

IT WAS INITIALLY REPORTED THAT THE USED DEVICE WOULD BE RETURNED FOR ANALYSIS. HOWEVER, THE ACTUAL DEVICE INVOLVED IN THE REPORTED INCIDENT WAS NOT RECD. WE WERE UNABLE TO CONFIRM THE REPORTED INCIDENT DURING VISUAL EXAMINATION OF THE FILE SAMPLE FROM THE INVOLVED LOT NUMBER. A REVIEW OF THE BATCH RECORD REVEALED THE LOT MET PRODUCT SPECIFICATION REQUIREMENT. A REVIEW OF OUR PRODUCT SURVEILLANCE FILES REVEALED THIS LOT NUMBER RECD NO OTHER SIMILAR REPORTS.

 

6.

BRAND NAME

SPROTTE

TYPE OF DEVICE

SPINAL NEEDLE

MANUFACTURER (Section D)

B. BRAUN MEDICAL, INC.

824 TWELFTH AVE.

BETHLEHEM PA 18018

 

DEVICE EVENT KEY

248763

MDR REPORT KEY

256886

EVENT KEY

240773

REPORT NUMBER

256886

DEVICE SEQUENCE NUMBER

1

PRODUCT CODE

BSP

REPORT SOURCE

VOLUNTARY

REPORT DATE

12/17/1999

1 DEVICE WAS INVOLVED IN THE EVENT

 

1 PATIENT WAS INVOLVED IN THE EVENT

 

DATE FDA RECEIVED

12/17/1999

IS THIS AN ADVERSE EVENT REPORT?

NO

IS THIS A PRODUCT PROBLEM REPORT?

YES

DEVICE OPERATOR

HEALTH PROFESSIONAL

DEVICE LOT NUMBER

60044070

OTHER DEVICE ID NUMBER

2001-02

WAS DEVICE AVAILABLE FOR EVALUATION?

DEVICE NOT RETURNED TO MANUFACTURER

DATE RETURNED TO MANUFACTURER

12/15/1999

PATIENT OUTCOME

OTHER 

 

ADVERSE EVENT OR PRODUCT PROBLEM DESCRIPTION

REPORT DATE: 12/17/1999  MDR TEXT KEY: 871368 Patient Sequence Number: 1

SPINAL ANESTHESIA BEING ATTEMPTED IN PREPARATION FOR ARTHROSCOPY OF LEFT ANKLE. PT SLIGHTLY UNCOOPERATIVE, RAISING UP AND MOVING WITH THE SLIGHTEST TOUCH TO BACK.

 

7.

BRAND NAME

SPROTTE PENCIL POINT SPINAL NEEDLE (WITHOUT INTRODUCER)

TYPE OF DEVICE

SPINAL NEEDLE

BASELINE BRAND NAME

SPROTTE PENCIL POINT SPINAL NEEDLE

BASELINE GENERIC NAME

SPINAL NEEDLE

BASELINE CATALOGUE NUMBER

03115130A

BASELINE DEVICE FAMILY

EPIDURAL NEEDLE

BASELINE DEVICE 510(K) NUMBER

K911260

BASELINE SHELF LIFE INFORMATION

*

IS BASELINE PMA NUMBER PROVIDED?</< TH>

NO

BASELINE PREAMENDMENT?

NO

TRANSITIONAL?

NO

510(K) EXEMPT?

NO

MANUFACTURER (Section F)

RUSCH, INC.

2450 MEADOWBROOK PKWY.

DULUTH GA 30096

 

MANUFACTURER (Section D)

RUSCH, INC.

2450 MEADOWBROOK PKWY.

DULUTH GA 30096

 

MANUFACTURER (Section G)

RUSCH, INC.

2450 MEADOWBROOK PKWY.

 

DULUTH GA 30096

 

MANUFACTURER CONTACT

KATRINA HALBIG

2450 MEADOWBROOK PARKWAY

DULUTH , GA 30136

(770) 623 -0816

 

DEVICE EVENT KEY

223213

MDR REPORT KEY

230157

EVENT KEY

216058

REPORT NUMBER

2429473-1999-00058

DEVICE SEQUENCE NUMBER

1

PRODUCT CODE

GDM

REPORT SOURCE

MANUFACTURER

SOURCE TYPE

USER FACILITY

EVENT TYPE

INJURY

TYPE OF REPORT

INITIAL,FOLLOWUP

REPORT DATE

06/29/1999

1 DEVICE WAS INVOLVED IN THE EVENT

 

1 PATIENT WAS INVOLVED IN THE EVENT

 

DATE FDA RECEIVED

07/01/1999

IS THIS AN ADVERSE EVENT REPORT?

YES

IS THIS A PRODUCT PROBLEM REPORT?

YES

DEVICE OPERATOR

HEALTH PROFESSIONAL

DEVICE CATALOGUE NUMBER

03115130A

WAS DEVICE AVAILABLE FOR EVALUATION?

YES

IS THE REPORTER A HEALTH PROFESSIONAL?

UNKNOWN

WAS THE REPORT SENT TO FDA?

NO

DATE MANUFACTURER RECEIVED

06/17/1999

WAS DEVICE EVALUATED BY MANUFACTURER?

DEVICE NOT RETURNED TO MANUFACTURER

IS THE DEVICE SINGLE USE?

YES

TYPE OF DEVICE USAGE

INITIAL

PATIENT OUTCOME

REQUIRED INTERVENTION 

 

ADVERSE EVENT OR PRODUCT PROBLEM DESCRIPTION

REPORT DATE: 06/29/1999  MDR TEXT KEY: 767910 Patient Sequence Number: 1

IT WAS REPORTED THAT THE PT WAS UNDERGOING AN ELECTIVE CESAREAN SECTION UNDER SPINAL BLOCK ANESTHESIA. AN INTRODUCER WAS PLACED, AND THEN THE SPROTTE NEEDLE WAS PLACED. SPINAL FLUID WAS NOT OBTAINED; THE INTRODUCER AND NEEDLE WERE REMOVED. UPON REMOVAL, IT WAS NOTED THAT THE DISTAL PORTION OF THE NEEDLE WAS NOT REMOVED. AFTER THE PROCEDURE, THE PT UNDERWENT AN ADD'L PROCEDURE TO REMOVE THE TIP. NO FURTHER CONSEQUENCES WERE NOTED.

 

ADDITIONAL MANUFACTURER NARRATIVE

REPORT DATE: 06/29/1999  MDR TEXT KEY: 767913 

DEVICE EVALUATION ANTICIPATED, BUT NOT YET BEGUN.

 

ADDITIONAL MANUFACTURER NARRATIVE

REPORT DATE: 06/29/1999  MDR TEXT KEY: 787394 

DEVICE EVAL NOT POSSIBLE, AS ALLEGEDLY DEFECTIVE DEVICE HAS NOT BEEN RETURNED FOR MFR'S INVESTIGATION.

 

8.

BRAND NAME

SPROTTE PENCIL POINT SPINAL NEEDLE

TYPE OF DEVICE

SPINAL NEEDLE

BASELINE BRAND NAME

SPROTTE PENCIL POINT SPINAL NEEDLE

BASELINE GENERIC NAME

SPROTTE NEEDLE

BASELINE CATALOGUE NUMBER

00115130A

BASELINE DEVICE FAMILY

SPROTTE, TUOHY NEEDLE

BASELINE DEVICE 510(K) NUMBER

K911260

BASELINE SHELF LIFE INFORMATION

*

IS BASELINE PMA NUMBER PROVIDED?</< TH>

NO

BASELINE PREAMENDMENT?

NO

TRANSITIONAL?

NO

510(K) EXEMPT?

NO

MANUFACTURER (Section G)

RUSCH, INC.

2450 MEADOWBROOK PKWY.

 

DULUTH GA 30096

 

MANUFACTURER CONTACT

JEAN VAN DER SOMMEN

250 MEADOWBROOK PKWY.

DULUTH , GA 30136

(770) 623 -0816

 

DEVICE EVENT KEY

85965

MDR REPORT KEY

90315

EVENT KEY

81654

REPORT NUMBER

2429473-1997-00045

DEVICE SEQUENCE NUMBER

1

PRODUCT CODE

BSP

REPORT SOURCE

MANUFACTURER

SOURCE TYPE

USER FACILITY

EVENT TYPE

INJURY

TYPE OF REPORT

INITIAL

1 DEVICE WAS INVOLVED IN THE EVENT

 

1 PATIENT WAS INVOLVED IN THE EVENT

 

DATE FDA RECEIVED

05/09/1997

IS THIS AN ADVERSE EVENT REPORT?

NO

DEVICE OPERATOR

HEALTH PROFESSIONAL

DEVICE CATALOGUE NUMBER

00115130A

DEVICE LOT NUMBER

299

WAS DEVICE AVAILABLE FOR EVALUATION?

YES

DATE MANUFACTURER RECEIVED

05/08/1997

WAS DEVICE EVALUATED BY MANUFACTURER?

NO

IS THE DEVICE SINGLE USE?

NO ANSWER PROVIDED

TYPE OF DEVICE USAGE

UNKNOWN

 

9.

BRAND NAME

SPROTTE SPINAL NEEDLE

TYPE OF DEVICE

SPINAL NEEDLE

BASELINE BRAND NAME

SPROTTE PENCIL POINT SPINAL NEEDLE

BASELINE GENERIC NAME

SPROTTE NEEDLE

BASELINE CATALOGUE NUMBER

00115130A

BASELINE DEVICE FAMILY

SPROTTE, TUOHY NEEDLE

BASELINE DEVICE 510(K) NUMBER

K911260

BASELINE SHELF LIFE INFORMATION

*

IS BASELINE PMA NUMBER PROVIDED?</< TH>

NO

BASELINE PREAMENDMENT?

NO

TRANSITIONAL?

NO

510(K) EXEMPT?

NO

MANUFACTURER (Section D)

RUSCH, INC.

2450 MEADOWBROOK PKWY

DULUTH GA 30136

 

DEVICE EVENT KEY

85965

MDR REPORT KEY

86780

EVENT KEY

81654

REPORT NUMBER

86780

DEVICE SEQUENCE NUMBER

1

PRODUCT CODE

BSP

REPORT SOURCE

VOLUNTARY

REPORT DATE

04/15/1997

1 DEVICE WAS INVOLVED IN THE EVENT

 

1 PATIENT WAS INVOLVED IN THE EVENT

 

DATE FDA RECEIVED

04/28/1997

IS THIS AN ADVERSE EVENT REPORT?

NO

IS THIS A PRODUCT PROBLEM REPORT?

YES

DEVICE OPERATOR

HEALTH PROFESSIONAL

DEVICE EXPIRATION DATE

09/01/1999

DEVICE LOT NUMBER

299

WAS DEVICE AVAILABLE FOR EVALUATION?

NO ANSWER PROVIDED

 

ADVERSE EVENT OR PRODUCT PROBLEM DESCRIPTION

REPORT DATE: 04/15/1997  MDR TEXT KEY: 225055 Patient Sequence Number: 1

DURING ROUTINE PERFORMANCE OF A SPINAL ANESTHETIC FOR C-SECTION, THE NEEDLE SEPARATED AT THE HUB LEAVING ONLY THE METAL PART OF THE NEEDLE IN THE PT. AN INTRODUCER HAD BEEN USED AND THE PT WAS THIN SO IT WAS EASY TO RETRIEVE THE SEPARATED NEEDLE AND REINSERT A NEW NEEDLE. HOWEVER, IN A LARGE PT, THE SEPARATED NEEDLE COULD HAVE BEEN LOST TO RETRIEVAL UNDER THE SKIN AND SO, REQUIRING A MINOR SURGICAL PROCEDURE TO REMOVE IT.

 

10.

BRAND NAME

PAJUNK SPROTTE NEEDLE

TYPE OF DEVICE

SPROTTE NEEDLE

MANUFACTURER (Section F)

PAJUNK

AM HOLZPLATZ 5-7

D-78187 GELSINGEN

GERMANY

 

MANUFACTURER (Section D)

PAJUNK

AM HOLZPLATZ 5-7

D-78187 GELSINGEN

GERMANY

 

DEVICE EVENT KEY

36148

MDR REPORT KEY

34768

EVENT KEY

32665

REPORT NUMBER

34768

DEVICE SEQUENCE NUMBER

1

PRODUCT CODE

CAZ

REPORT SOURCE

DISTRIBUTOR

TYPE OF REPORT

INITIAL

REPORT DATE

07/16/1996

1 DEVICE WAS INVOLVED IN THE EVENT

 

1 PATIENT WAS INVOLVED IN THE EVENT

 

DATE FDA RECEIVED

07/16/1996

IS THIS AN ADVERSE EVENT REPORT?

NO

IS THIS A PRODUCT PROBLEM REPORT?

YES

DEVICE OPERATOR

HEALTH PROFESSIONAL

DEVICE EXPIRATION DATE

10/01/1998

DEVICE CATALOGUE NUMBER

04115130A

DEVICE LOT NUMBER

263

WAS DEVICE AVAILABLE FOR EVALUATION?

YES

IS THE REPORTER A HEALTH PROFESSIONAL?

NO

WAS THE REPORT SENT TO FDA?

YES

DATE REPORT TO FDA

07/16/1996

DISTRIBUTOR FACILITY AWARE DATE

07/16/1996

DEVICE AGE

UNKNOWN

EVENT LOCATION

HOSPITAL

DATE REPORT TO MANUFACTURER

07/16/1996

PATIENT OUTCOME

OTHER 

 

ADVERSE EVENT OR PRODUCT PROBLEM DESCRIPTION

REPORT DATE: 07/16/1996  MDR TEXT KEY: 49467 Patient Sequence Number: 1

WHILE PLACING A COMBINED A SPINAL EPIDURAL, THE NEEDLE STYLET STUCK AND COULD NOT BE EASILY REMOVED FROM THE NEEDLE.

 

11.

BRAND NAME

SPROTTE NEEDLE

TYPE OF DEVICE

24G SPINAL ANESTHESIA NEEDLE

MANUFACTURER (Section F)

IMD

528 PARK AVENUE

PARK CITY UT 84068 1180

 

MANUFACTURER (Section D)

IMD

528 PARK AVENUE

PARK CITY UT 84068 1180

 

DEVICE EVENT KEY

10090

MDR REPORT KEY

10090

EVENT KEY

5390

REPORT NUMBER

10090

DEVICE SEQUENCE NUMBER

1

PRODUCT CODE

BSP

REPORT SOURCE

USER FACILITY

TYPE OF REPORT

INITIAL

REPORT DATE

07/30/1993

1 DEVICE WAS INVOLVED IN THE EVENT

 

1 PATIENT WAS INVOLVED IN THE EVENT

 

DATE FDA RECEIVED

08/31/1993

IS THIS AN ADVERSE EVENT REPORT?

YES

IS THIS A PRODUCT PROBLEM REPORT?

YES

DEVICE OPERATOR

HEALTH PROFESSIONAL

DEVICE LOT NUMBER

158

WAS DEVICE AVAILABLE FOR EVALUATION?

YES

IS THE REPORTER A HEALTH PROFESSIONAL?

YES

WAS THE REPORT SENT TO FDA?

NO

DISTRIBUTOR FACILITY AWARE DATE

07/26/1993

EVENT LOCATION

HOSPITAL

DATE REPORT TO MANUFACTURER

07/30/1993

PATIENT OUTCOME

OTHER 

 

ADVERSE EVENT OR PRODUCT PROBLEM DESCRIPTION

REPORT DATE: 07/30/1993  MDR TEXT KEY: 5526 Patient Sequence Number: 1

24 GUAGE SPROTTLE NEEDLE, USED TO DELIVER SPINAL ANESTHESIA, BROKE OFF. 1-1/2" NEEDLE SEGMENT SURGICALLY REMOVED (UNDER LOCAL ANESTHESIA) WITH NO CLINICAL SEQUELAE TO PATIENT. SPINAL BEING ADMINISTERED POST DELIVERY IN PREPARATION FOR POST-PARTUM TUBAL LIGATION. NEEDLE BROKEN WITHDRAWAL P.P.T.L. CANCELLED.

 

12.

BRAND NAME

SPROTTE SPINAL NEEDLE 24 GAX3-1/2"

TYPE OF DEVICE

SPINAL NEEDLE

MANUFACTURER (Section F)

HAVEL'S, INC.

 

 

MANUFACTURER (Section D)

HAVEL'S, INC.

 

 

DEVICE EVENT KEY

1242

MDR REPORT KEY

1298

EVENT KEY

1112

REPORT NUMBER

1298

DEVICE SEQUENCE NUMBER

1

PRODUCT CODE

BSP

REPORT SOURCE

USER FACILITY

TYPE OF REPORT

INITIAL

REPORT DATE

08/21/1992

1 DEVICE WAS INVOLVED IN THE EVENT

 

1 PATIENT WAS INVOLVED IN THE EVENT

 

DATE FDA RECEIVED

09/01/1992

IS THIS AN ADVERSE EVENT REPORT?

NO

IS THIS A PRODUCT PROBLEM REPORT?

YES

DEVICE OPERATOR

OTHER HEALTH CARE PROFESSIONAL

DEVICE EXPIRATION DATE

06/01/1997

DEVICE MODEL NUMBER

NO. S-2490

DEVICE CATALOGUE NUMBER

AD 2490

DEVICE LOT NUMBER

154

OTHER DEVICE ID NUMBER

PAT. NO. 3020926

WAS DEVICE AVAILABLE FOR EVALUATION?

YES

IS THE REPORTER A HEALTH PROFESSIONAL?

UNKNOWN

WAS THE REPORT SENT TO FDA?

YES

DATE REPORT TO FDA

08/21/1992

DISTRIBUTOR FACILITY AWARE DATE

08/11/1992

DEVICE AGE

01-JUN-92

EVENT LOCATION

HOSPITAL

DATE REPORT TO MANUFACTURER

08/17/1992

PATIENT OUTCOME

OTHER 

 

ADVERSE EVENT OR PRODUCT PROBLEM DESCRIPTION

REPORT DATE: 08/21/1992  MDR TEXT KEY: 1132 Patient Sequence Number: 1

AT APPROX. 0730 HOURS, 8/11/92, OPERATING RM #2, A SPINAL ANESTHETIC WAS ATTEMPTED ON A 36 YEAR OLD FEMALE USING A SPROTTE SPINAL NEEDLE, THROUGH A THINWALL INTRODUCER. THE INTRODUCER WAS POSITIONED L2-3 INTERSPACE, SPROTTE SPINAL NEEDLE WAS ADVANCED, BONE FELT, SPINAL NEEDLE WITHDRAWN INTO INTRODUCER NEEDLE, REPOSITIONED, SPINAL NEEDLE WAS ADVANCED, STYLET REMOVED, BLOOD RETURN, BOTH NEEDLES WERE REMOVED, SPINAL NEEDLE STRAIGHT INTACT. INTRODUCER WAS THEN POSITIONED L3-4 INTERSPACE, NEW SPROTTEE SPINAL NEEDLE ADVANCED, BONE FELT, SPINAL NEEDLE WITHDRAWN INTO INTRODUCER NEEDLE, REPOSITIONED NEEDLES, SPINAL NEEDLE ADVANCE, STYLET REMOVED, CLEAR SPINAL FLUID OBSERVED COMING FROM HUB OF SPINAL NEEDLE, SYRINGE WITH ANESTHETIC ATTACHED TO SPINAL NEEDLE, ASPIRATED NEEDLE ROTATED (NO RESISTENCE FELT), ONLY A PORTION OF SPINAL NEEDLE REMOVED, X-RAY PATIENT SPINE DEMONSTRATED REMAINING PORTION OF SPINAL NEEDLE, PATIENT WAS LATER TRANSFERRED TO MARSHFIELD HOSPITAL WHERE BROKEN OFF PORTION OF SPINAL NEEDLE WAS REMOVED 8/11/92. NO ADVERSE SEQUELA TO PATIENT AS OF AUGUST 14, 1992 DEVICE LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: SATISFACTORY CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT. INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY. NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED. DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: A DEVICE FROM SAME LOT WAS EVALUATED, VISUAL EXAMINATION. RESULTS OF EVALUATION: COMPONENT FAILURE, TELEMETRY FAILURE, NONE OR UNKNOWN, NONE OR UNKNOWN. CONCLUSION: INVALID DATA. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: YES. CORRECTIVE ACTIONS: NONE OR UNKNOWN. THE DEVICE WAS NOT DESTROYED/DISPOSED OF.