FDA Adverse Event Malfunction Summary report: N

MICROTEK

MDR report key: 22749005 · Received August 8, 2025

Report

Report Number
8043817-2025-00004
Event Type
Malfunction
Date Received
August 8, 2025
Date of Event
July 8, 2025
Report Date
August 8, 2025
Manufacturer
MICROTEK MEDICAL LLC
Product Code
PUI
UDI-DI
00748426066896
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
IN, US
Reporter Occupation
501

Narratives

Description of Event or Problem · 0

IT WAS REPORTED THAT A FOREIGN OBJECT, GLASS FRAGMENT, WAS EMBEDDED IN THE REAR SECTION OF THE MICROTEK PACEMAKER DRAPE (REF #PD201, LOT 4364LRO000). DURING THE DRAPING PROCESS IN THE CATHETERIZATION LABORATORY (CATH LAB), THE FRAGMENT MADE CONTACT WITH A RADIATION TECHNICIAN. THE GLASS WAS PARTIALLY PROTRUDING FROM THE FABRIC AND CAUSED A POKE TO THE TECHNICIAN. HOWEVER, THE CONTACT DID NOT RESULT IN SKIN PENETRATION, LACERATION, OR ANY REPORTABLE INJURY. THE INCIDENT WAS PROMPTLY DOCUMENTED BY THE REPORTER, AND PHOTOGRAPHIC EVIDENCE WAS COLLECTED TO SUPPORT THE COMPLAINT. NO PATIENT CONTACT OCCURRED, AND THERE WERE NO REPORTED INFECTIONS, COMPLICATIONS, OR ADVERSE CLINICAL OUTCOMES ASSOCIATED WITH THE EVENT. THE MANUFACTURER CONDUCTED AN INVESTIGATION BUT WAS UNABLE TO DETERMINE THE ORIGIN OF THE FOREIGN MATERIAL. NO ROOT CAUSE WAS IDENTIFIED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
203538 MICROTEK PACEMAKER DRP 86X135IN W-FENS PUI MICROTEK MEDICAL LLC PD201 00748426066896

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown