FDA Adverse Event Malfunction Summary report: N

WECK HZ APPLIER SMALL 6" CVD

MDR report key: 21105038 · Received January 8, 2025

Report

Report Number
3011137372-2025-00020
Event Type
Malfunction
Date Received
January 8, 2025
Date of Event
December 23, 2024
Report Date
December 23, 2024
Manufacturer
TELEFLEX MEDICAL
Product Code
GDO
UDI-DI
34026704622598
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
JA
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

QN#(B)(4). THE SAMPLE WAS RETURNED TO THE MANUFACTURER FOR EVALUATION. THE MANUFACTURER REPORTED: "PER CUSTOMER PROVIDED INFORMATION THE DHR FOR THE ALLEGED DEFECTIVE MEDICAL DEVICE WAS REVIEWED AND FOUND COMPLETE WITHOUT ANY IRREGULARITIES. THE ALLEGED DEFECTIVE INSTRUMENT WAS PRODUCED AT THE TECOMET, INC. KENOSHA, WI FACILITY AS PART OF A (B)(4) PC LOT IN OCTOBER OF 2021. IT WAS FOUND THAT THIS ORDER WAS MADE FROM THE CORRECT MATERIALS AND COMPONENTS, AND ALL APPROVED PROCESSES WERE FOLLOWED. AFTER A VISUAL AND FUNCTIONAL INSPECTION WAS CONDUCTED, IT WAS CONCLUDED THE JAWS ARE ALIGNED AND ARE FUNCTIONING CORRECTLY. ALL (B)(4) INSTRUMENTS FROM THIS LOT WERE 100% VISUALLY INSPECTED AND FUNCTION TESTED PRIOR TO SHIPMENT TO THE CUSTOMER AS THIS IS A STANDARDIZED PROCEDURE AT THIS FACILITY FOR THIS PRODUCT LINE. DUE TO THESE FINDINGS, NO FURTHER ACTIONS WILL BE TAKEN IN RESPONSE TO THIS COMPLAINT AND THIS RECORD WILL BE DEEMED CLOSED. ALL 100 INSTRUMENTS FROM THIS LOT WERE 100% VISUALLY INSPECTED AND FUNCTION TESTED PRIOR TO SHIPMENT TO THE CUSTOMER AS THIS IS A STANDARDIZED PROCEDURE AT THIS FACILITY FOR THIS PRODUCT LINE. DUE TO THESE FINDINGS, NO FURTHER ACTIONS WILL BE TAKEN IN RESPONSE TO THIS COMPLAINT AND THIS RECORD WILL BE DEEMED CLOSED." TELEFLEX WILL CONTINUE TO MONITOR AND TREND ON COMPLAINTS OF THIS NATURE.

Additional Manufacturer Narrative · 0

(B)(4). THE SAMPLE WAS NOT RETURNED TO THE MANUFACTURER FOR EVALUATION. THE MANUFACTURER REPORTED: "PER CUSTOMER PROVIDED INFORMATION THE DHR FOR THE ALLEGED DEFECTIVE MEDICAL DEVICE WAS REVIEWED AND FOUND COMPLETE WITHOUT ANY IRREGULARITIES. THE ALLEGED DEFECTIVE INSTRUMENT WAS PRODUCED AT THE TECOMET, INC. KENOSHA, WI FACILITY AS PART OF A 100-PC LOT IN OCTOBER OF 2021. IT WAS FOUND THAT THIS ORDER WAS MADE FROM THE CORRECT MATERIALS AND COMPONENTS, AND ALL APPROVED PROCESSES WERE FOLLOWED. THIS INSTRUMENT HAS NOT BEEN RETURNED FOR REVIEW OR EVALUATION THEREFORE WE ARE UNABLE TO DETERMINE WHAT MAY HAVE CAUSED THE ALLEGED DEFECT OR VALIDATE THE ALLEGED COMPLAINT. ALL 100 INSTRUMENTS FROM THIS LOT WERE 100% VISUALLY INSPECTED AND FUNCTION TESTED PRIOR TO SHIPMENT TO THE CUSTOMER AS THIS IS A STANDARDIZED PROCEDURE AT THIS FACILITY FOR THIS PRODUCT LINE. DUE TO THESE FINDINGS, NO FURTHER ACTIONS WILL BE TAKEN IN RESPONSE TO THIS COMPLAINT AND THIS RECORD WILL BE DEEMED CLOSED." TELEFLEX WILL CONTINUE TO MONITOR AND TREND ON COMPLAINTS OF THIS NATURE. OTHER REMARKS: N/A. CORRECTED DATA: N/A.

Additional Manufacturer Narrative · 0

(B)(4) .

Description of Event or Problem · 0

IT WAS REPORTED THAT "THE APPLIER JAWS WERE FOUND MISALIGNED BEFORE USE. THEREFORE, A NEW UNIT WAS USED INSTEAD".

Description of Event or Problem · 0

IT WAS REPORTED THAT "THE APPLIER JAWS WERE FOUND MISALIGNED BEFORE USE. THEREFORE, A NEW UNIT WAS USED INSTEAD".

Description of Event or Problem · 0

IT WAS REPORTED THAT "THE APPLIER JAWS WERE FOUND MISALIGNED BEFORE USE. THEREFORE, A NEW UNIT WAS USED INSTEAD".

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1641237 WECK HZ APPLIER SMALL 6" CVD APPLIER, SURGICAL, CLIP GDO TELEFLEX MEDICAL 06K2140835 34026704622598

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown