FDA Adverse Event Malfunction Summary report: N

SUCTION TUBE MCEN770B30 BLUNT TIP

MDR report key: 19621255 · Received June 26, 2024

Report

Report Number
3003249645-2024-00033
Event Type
Malfunction
Date Received
June 26, 2024
Report Date
August 21, 2024
Manufacturer
INTEGRA MICROFRANCE S.A.S.
Product Code
JZF
PMA / PMN Number
EXEMPT
Product Problem
Yes
Report Source
Manufacturer report
Reporter Occupation
PHARMACIST
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

IT WAS SUBSEQUENTLY REPORTED THAT THE NUMBER OF USES FOR THIS INSTRUMENT IS UNKNOWN AND CANNOT BE ESTIMATED. AN AWARENESS TRAINING HAS BEEN PROVIDED TO THE OPERATORS TO RE-ENFORCE GOOD WELDING PRACTICES.

Additional Manufacturer Narrative · 0

THE BLUNT TIP SUCTION TUBE (MCEN770B30) WAS RETURNED FOR EVALUATION: THE DEVICE HISTORY RECORD (DHR) WAS REVIEWED, AND NO ANOMALIES RELATED TO THE REPORTED FAILURE WERE OBSERVED. FAILURE ANALYSIS: EVALUATION OF THE SUCTION TUBE FOUND THAT THE STEM WAS UNSOLDERED FROM THE HANDLE. ROOT CAUSE ANALYSIS: IT WAS DETERMINED THAT THE PROBLEM WAS DUE TO POOR WELD FINISHING DURING MANUFACTURING OPERATIONS.

Description of Event or Problem · 0

N/A.

Description of Event or Problem · 0

THIS REPORT IS 6 OF 10 AND IS RELATED TO MFG REPORT NUMBERS: 3003249645-2024-00029, 3003249645-2024-00028, 3003249645-2024-00031, 3003249645-2024-00030, 3003249645-2024-00032, 3003249645-2024-00034, 3003249645-2024-00035, 3003249645-2024-00036 AND 3003249645-2024-00037. IT WAS REPORTED THAT ON A UNSPECIFIED DATE, THE WELDING OF THE BLUNT TIP SUCTION TUBE (MCEN770B30) BROKE BETWEEN THE HANDLE AND STEM. ANOTHER DEVICE WAS AVAILABLE FOR USE. NO INFORMATION ON PATIENT IMPACT IS AVAILABLE AT THIS TIME.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2102208 SUCTION TUBE MCEN770B30 BLUNT TIP PFM11 JZF INTEGRA MICROFRANCE S.A.S. 5347090

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown