BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    INTIMA-II Y18GAX1.16IN PRN/EC SLM

    MDR report key: 11008614 · Received December 15, 2020

    Report

    Report Number
    3006948883-2020-00948
    Event Type
    Malfunction
    Date Received
    December 15, 2020
    Date of Event
    November 7, 2020
    Report Date
    January 6, 2021
    Manufacturer
    BD (SUZHOU)
    Product Code
    FOZ
    PMA / PMN Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CH
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 0

    H.6. INVESTIGATION: A DEVICE HISTORY REVIEW WAS CONDUCTED FOR LOT NUMBER 0140311. OUR RECORDS SHOW THAT THIS IS THE ONLY INSTANCE OF THIS ISSUE OCCURRING IN THIS PRODUCTION BATCH. ACCORDING TO THE SAMPLING PLAN APPLIED FOR PRODUCT PERFORMANCE, THIS LOT WAS ACCEPTED AND RELEASED WITHOUT DEFECTS BEING NOTED DURING THE FINAL ASSEMBLY OR VISUAL INSPECTIONS. A SAMPLE COULD NOT BE OBTAINED FOR EVALUATION AND TESTING; IN LIEU OF THE AFFECTED DEVICE, FUNCTIONAL TESTING WAS PERFORMED ON RETENTION SAMPLES FOR THIS LOT, THE RESULTS OF THESE SHOW THAT THE TESTED UNITS PERFORMED WITHIN PRODUCT SPECIFICATIONS. UNFORTUNATELY WITHOUT THE ABILITY TO INVESTIGATE THE AFFECTED UNIT OUR QUALITY ENGINEERS WERE UNABLE TO DETERMINE THE ROOT CAUSE FOR THIS COMPLAINT.

    Description of Event or Problem · 0

    IT WAS REPORTED THAT INTIMA-II Y18GAX1.16IN PRN/EC SLM CATHETER BROKE. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: THE CATHETER TUBE WAS BROKEN WHEN THE NEEDLE WAS PIERCED INTO THE BLOOD VESSEL AND PERFORMING PUNCTURING.

    Additional Manufacturer Narrative · 1

    A DEVICE EVALUATION AND/OR DEVICE HISTORY REVIEW IS ANTICIPATED, BUT IS NOT COMPLETE. UPON COMPLETION, A SUPPLEMENTAL REPORT WILL BE FILED. (B)(4).

    Description of Event or Problem · 1

    IT WAS REPORTED THAT INTIMA-II Y18GAX1.16IN PRN/EC SLM CATHETER BROKE. THE FOLLOWING INFORMATION WAS PROVIDED BY THE INITIAL REPORTER: THE CATHETER TUBE WAS BROKEN WHEN THE NEEDLE WAS PIERCED INTO THE BLOOD VESSEL AND PERFORMING PUNCTURING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1479251 INTIMA-II Y18GAX1.16IN PRN/EC SLM CATHETER FOZ BD (SUZHOU) 0140311

    Patients

    Seq Age Sex Outcome Treatment
    1