FDA Adverse Event Malfunction Summary report: N

ADJ FLANGE NON LATEX NASA

MDR report key: 21263313 · Received January 29, 2025

Report

Report Number
8040412-2025-00017
Event Type
Malfunction
Date Received
January 29, 2025
Date of Event
December 13, 2024
Report Date
January 6, 2025
Manufacturer
TELEFLEX MEDICAL SDN. BHD.
Product Code
BTQ
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
OR, US
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

(B)(4). FULL UDI NOT AVAILABLE AS THE LOT# WAS NOT PROVIDED BY THE CUSTOMER.

Additional Manufacturer Narrative · 0

QN#(B)(4). FULL UDI NOT AVAILABLE AS THE LOT# WAS NOT PROVIDED BY THE CUSTOMER. THE SAMPLE WAS RETURNED TO THE MANUFACTURER FOR EVALUATION. THE MANUFACTURER REPORTED: FROM SAMPLE RECEIVED, THERE IS MOISTURE CONTAINED ON THE SURFACE OF PRODUCT EVEN PACKAGING SEALING IS IN GOOD CONDITION. DEVICE HISTORY RECORD REVIEW WAS CONDUCTED, NO RELEVANT FINDINGS. THE DEVICE PASSED ALL MANUFACTURING SPECIFICATIONS PRIOR TO RELEASE. THERE IS NO FAILURE BASED ON THE FUNCTIONALITY BUT VISUAL THERE IS MOISTURE ON THE SURFACE OF PRODUCT. BASED ON THE INVESTIGATION, IT IS CONFIRMED AND VERIFIED THAT THERE IS A FAILURE AS PER REPORTED. MOISTURE INSIDE PACKAGING WERE FOUND DURING INVESTIGATION. CORRECTIVE AND PREVENTIVE ACTION HAD BEEN ADDRESSED FOR THIS ISSUE.

Description of Event or Problem · 0

IT WAS REPORTED THAT: "CONDENSATION IN PACKAGING ON TUBE, DON'T SEE ANY PACKAGE DAMAGE". ASSOCIATED COMPLAINTS 8040412-2025-00002, 8 040412-2025-00003, 8040412-2025-00004 AND 8040412-2025-00005.

Description of Event or Problem · 0

IT WAS REPORTED THAT: "CONDENSATION IN PACKAGING ON TUBE, DON'T SEE ANY PACKAGE DAMAGE". ASSOCIATED COMPLAINTS 8040412-2025-00002, 8 040412-2025-00003, 8040412-2025-00004 AND 8040412-2025-00005.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
892424 ADJ FLANGE NON LATEX NASA AIRWAY, NASOPHARYNGEAL BTQ TELEFLEX MEDICAL SDN. BHD. 20G21

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown