FDA Adverse Event Malfunction Summary report: N

FOLYSIL SILICONE CATHETER

MDR report key: 20091477 · Received August 28, 2024

Report

Report Number
9610711-2024-00218
Event Type
Malfunction
Date Received
August 28, 2024
Date of Event
August 1, 2024
Report Date
December 20, 2024
Manufacturer
COLOPLAST A/S
Product Code
EZL
PMA / PMN Number
K233411
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
FR
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

AFTER RECEIVING THIS COMPLAINT, WE SEARCHED FOR OTHER COMPLAINTS AND WE FOUND NONE REGARDING THE LOT NUMBER 9316062 WITH THE SAME DEFECT. WE RECEIVED ONE SAMPLE NOT SEALED WITH SAME ITEM NUMBER AND SAME LOT NUMBER. THIS SAMPLE WAS INFLATED WITH 10ML OF WATER AND NO BURSTING OR BALLOONS DEFECT WERE OBSERVED. BALLOON ISSUE (BURSTING ISSUE, DEFLATING ISSUE) WERE KNOWN AND COULD COME FROM VARIOUS CAUSES BUT ACCORDING TO THE AVAILABLE INFORMATION, WE CANNOT CONCLUDE ON A SPECIFIC ROOT CAUSE IN THIS CASE. CHECKING THE QUALITY DATABASES REVEALED THIS TYPE OF DEFECT IS KNOWN AND CLOSELY MONITORED. A SIMILAR CASE STUDY WAS PERFORMED BASED ON PRODUCT: FOLYSIL DHF, DEFECT, BURST FROM SEPTEMBER 2020 TO SEPTEMBER 2024, 178 SIMILAR CASES WERE FOUND. B3: ESTIMATED DATE.

Additional Manufacturer Narrative · 0

AFTER RECEIVING THIS COMPLAINT, WE SEARCHED FOR OTHER COMPLAINTS AND WE FOUND NONE REGARDING THE LOT NUMBER 9316062 WITH THE SAME DEFECT. B3: ESTIMATED DATE.

Description of Event or Problem · 0

ACCORDING TO THE AVAILABLE INFORMATION, THE BALLOON EXPLODED DURING INSERTION.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1478732 FOLYSIL SILICONE CATHETER INDWELLING URETHRAL DRAINAGE BALLOON CATHETER, NON-ANTIMICROBIAL EZL COLOPLAST A/S 9316062_HA61161002

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown