BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    NURSE ASSIST, LLC

    MDR report key: 18255616 · Received December 4, 2023

    Report

    Report Number
    3002695476-2023-00012
    Event Type
    Malfunction
    Date Received
    December 4, 2023
    Date of Event
    June 20, 2023
    Report Date
    December 4, 2023
    Manufacturer
    NURSE ASSIST, LLC
    Product Code
    FRO
    UDI-DI
    10850421008812
    PMA / PMN Number
    K083042
    Removal / Correction Number
    1650927-3OCT2023-001-R
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    003

    Narratives

    Additional Manufacturer Narrative · 0

    THE EXTENDED TIME BETWEEN DATE OF EVENT AND DATE OF THIS REPORT IS DUE TO NURSE ASSIST RECENTLY RECLASSIFYING THIS TYPE OF OCCURRENCE AS HAVING THE POTENTIAL FOR CAUSING OR CONTRIBUTING TO A DEATH OR A SERIOUS INJURY IF THE MALFUNCTION WERE TO RECUR. NURSE ASSIST IS CONDUCTING A RETROSPECTIVE REVIEW OF PRODUCT COMPLAINTS TO IDENTIFY ALL OCCURRENCES OF MALFUNCTION OF THE STERILE BARRIER.

    Description of Event or Problem · 0

    ON 4-JUL-2023, CUSTOMER NOTIFIED NURSE ASSIST VIA E-MAIL OF THE FOLLOWING EVENT DESCRIPTION FROM A CUSTOMER: (TRANSLATED) IS RUST INSIDE THE TRAY, IT APPEARS TO BE NACL LEAKING FROM THE BOTTLE AS IT IS ALMOST EMPTY. THIS IS THE THIRD KIT THAT CONTAINS RUST AND IS NOT USABLE. I'LL LET YOU KNOW IF THERE ARE ANY OTHERS. PHOTOS OF THE KIT IN QUESTION ARE ATTACHED. THESE BOTTLES WERE REPORTED BY THE INITIAL REPORTER AS LEAKING PRIOR TO USE ON A PATIENT. THERE WAS NO REPORT OF ANY PATIENT IMPACT OR ADVERSE EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1632660 NURSE ASSIST, LLC 0.9% NORMAL SLAINE FOR IRRIGATION USP, IN SCREW TOP BOTTLE FRO NURSE ASSIST, LLC 6240 22073614 10850421008812

    Patients

    Seq Age Sex Outcome Treatment
    1 Unknown