BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    HALYARD*®POLYISOPRENE MICRO POWDER-FREE STERILE SURGICAL GLOVES

    MDR report key: 17557571 · Received August 16, 2023

    Report

    Report Number
    3014421917-2023-00009
    Event Type
    Malfunction
    Date Received
    August 16, 2023
    Report Date
    October 31, 2023
    Manufacturer
    O&M HALYARD, INC.
    Product Code
    KGO
    UDI-DI
    30680651483202
    PMA / PMN Number
    K071746
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WV, US
    Reporter Occupation
    NURSE
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    THE PRODUCT INVOLVED IN THE EVENT WAS NOT AVAILABLE FOR RETURN. THE COMPLAINT COMPONENT SURGICAL POLYISOPRENE GLOVES, PART NUMBER 48320 IS MANUFACTURED BY ANSELL (FDA REGISTRATION 8041180). A SUPPLIER CORRECTIVE ACTION (SCAR) WAS SUBMITTED TO THE MANUFACTURER ON JULY 21, 2023. A FOLLOW-UP REPORT WILL BE PROVIDED UPON CONCLUSION OF INVESTIGATION AND RESPONSE BY THE MANUFACTURER. THIS PRODUCT INCIDENT IS DOCUMENTED IN THE O&M HALYARD, INC. COMPLAINT DATABASE AND IDENTIFIED AS COMPLAINT (B)(4). THIS INFORMATION IS SUBMITTED PURSUANT TO 21CFR803, IN COMPLIANCE WITH THE MEDICAL DEVICE REPORTING REQUIREMENT AND SHOULD NOT BE CONSIDERED TO BE AN ADMISSION THAT A O&M HALYARD, INC. PRODUCT IS DEFECTIVE OR HAS CAUSED SERIOUS INJURY.

    Additional Manufacturer Narrative · 0

    ***CORRECTION*** THE PRODUCT INVOLVED IN THE EVENT WAS NOT RETURNED FOR EVALUATION. THE COMPLAINT PRODUCT WAS MANUFACTURED BY ANSELL (FDA REGISTRATION: (B)(4)). O&M HALYARD, INC. SUBMITTED INITIAL MDR IN ERROR. O&M HALYARD, INC. IS THE INITIAL IMPORTER OF DEVICE; HOWEVER, THERE WAS NO SERIOUS INJURY OR ILLNESS (ADVERSE EVENT) ASSOCIATED WITH THIS COMPLAINT THEREFORE PURSUANT TO 21 CFR 803 A REPORT TO FDA IS NOT REQUIRED BY THE INITIAL IMPORTER. THE MANUFACTURER DID RESPOND TO SUPPLIER CORRECTIVE ACTION REQUEST WITH INVESTIGATION FINDINGS. NO SAMPLES WERE PROVIDED BY THE CUSTOMER. THE RETAINED SAMPLES WERE REVIEWED AND SHOWED NO SIMILAR REPORTED ISSUE. NO ABNORMALITIES WERE FOUND. THE DEVICE HISTORY RECORD WAS REVIEWED, NO ISSUES WERE FOUND. THERE WAS NO STOCK OF THE FINISHED GOOD AVAILABLE AT TIME OF INVESTIGATION. THE MANUFACTURER WAS UNABLE TO DEFINE A ROOT CAUSE. THIS PRODUCT INCIDENT IS DOCUMENTED IN THE O&M HALYARD, INC. COMPLAINT DATABASE AND IDENTIFIED AS COMPLAINT (B)(4). THIS INFORMATION IS SUBMITTED PURSUANT TO 21CFR803, IN COMPLIANCE WITH THE MEDICAL DEVICE REPORTING REQUIREMENT AND SHOULD NOT BE CONSIDERED TO BE AN ADMISSION THAT A O&M HALYARD, INC. PRODUCT IS DEFECTIVE OR HAS CAUSED SERIOUS INJURY. H3 OTHER TEXT : DEVICE NOT RETURNED.

    Description of Event or Problem · 0

    BOTH GLOVES RIPPED MID-CASE DURING USE. IT APPEARS TO BE A TEAR THE SIZE OF A PINHOLE. INCIDENT IS POTENTIALLY CAUSED BY A PUNCTURE OF SOME KIND. ADDITIONAL DETAILS REGARDING INCIDENT WAS ASKED OF REPORTER ON JULY 20 AND AUGUST 10, 2023. NO ADDITIONAL INFORMATION HAS BEEN MADE AVAILABLE AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    461351 HALYARD*®POLYISOPRENE MICRO POWDER-FREE STERILE SURGICAL GLOVES SURGICAL GLOVES POLYISOPRENE KGO O&M HALYARD, INC. 48320 2205020405 30680651483202

    Patients

    Seq Age Sex Outcome Treatment
    1 Unknown