FDA Adverse Event Malfunction Summary report: N

CONTACT DETACH

MDR report key: 23241780 · Received October 8, 2025

Report

Report Number
3003442380-2025-14740
Event Type
Malfunction
Date Received
October 8, 2025
Date of Event
April 9, 2025
Report Date
February 10, 2026
Manufacturer
UNOMEDICAL UM-D
Product Code
FPA
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CA, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

SUPPLEMENTAL REPORT 01- MDR (B)(4) ADDITIONAL INFORMATION - THIS MDR IS BEING SUBMITTED TO INCLUDE THE BELOW: H6: INVESTIGATION RESULTS UNDER TYPE OF INVESTIGATION, INVESTIGATION FINDINGS, INVESTIGATION CONCLUSIONS H11: INVESTIGATION SUMMARY. COMPLAINT INVESTIGATION RESULTS: A COMPLAINT INVESTIGATION HAS BEEN INITIATED UNDER COMPLAINT INVESTIGATION CHILD RECORD (B)(4). THE BATCH 6011130 IN QUESTION WAS MANUFACTURED AT THE REYNOSA SITE. DEVICE HISTORY RECORD (DHR) REVIEW: THE LOT 6011130 WAS MANUFACTURED ACCORDING TO THE WORK INSTRUCTION (WI) VERSION 98 AND PACKAGING IN THE MULTIVAC 14, ON 18-JAN-2025, WITH A TOTAL OF (B)(4) UNITS. THE SUB-ASSEMBLY, WELDING THE LOT 4M03247 WAS MANUFACTURED ACCORDING TO THE WI VERSION 34 WELDING IN THE MACHINE LS25 & LS24, ON 16-JAN-2025, WITH A TOTAL OF (B)(4) UNITS. THE LOT 4M03243 WAS MANUFACTURED ACCORDING TO THE WI VERSION 34 WELDING IN THE MACHINE LS06 & LS07, ON 06-JAN-2025, WITH A TOTAL OF (B)(4) UNITS. THE SUB-ASSEMBLY, GLUING OF CONNECTOR THE LOT 4M03223 WAS MANUFACTURED ACCORDING TO THE WI VERSION 37 IN THE GLUING OF CONNECTOR IN THE LINE 03, ON 07-JAN-2025, WITH A TOTAL OF (B)(4) UNITS. THE LOT 4M03226 WAS MANUFACTURED ACCORDING TO THE WI VERSION 37 IN THE GLUING OF CONNECTOR IN THE LINE 03, ON 17-JAN-2025, WITH A TOTAL OF (B)(4) UNITS. THE LOT 4M03220 WAS MANUFACTURED ACCORDING TO THE WI VERSION 37 IN THE GLUING OF CONNECTOR IN THE LINE 03, ON 22-DEC-2024, WITH A TOTAL OF (B)(4) UNITS. THE LOT 4M03222 WAS MANUFACTURED ACCORDING TO THE WI VERSION 37 IN THE GLUING OF CONNECTOR IN THE LINE 03, ON 06-JAN-2025, WITH A TOTAL OF (B)(4) UNITS. REVIEW OF THE DHR SHOWED THAT ALL RELEVANT TESTS REQUIRED DURING THE RELATED PROCESSES HAD BEEN FULFILLED AND MET THE REQUIREMENTS. NO DEVIATION WAS IDENTIFIED, NOR MAINTENANCE EVENTS WERE RECORDED RELATED TO COMPLAINT CODE. CONCLUSION SUMMARY OF COMPLAINT INVESTIGATION: AS A RESULT OF THE FOLLOWING: NO NON-CONFORMANCE (NC) RAISED DURING PRODUCTION RELATED TO COMPLAINT CODE, NO TREND IDENTIFIED FOR THE LOT IN QUESTION AND MALFUNCTION CODE, NO FURTHER ACTIONS ARE REQUIRED. THIS COMPLAINT WILL NOT REQUIRE FURTHER ROOT CAUSE INVESTIGATION NOR CORRECTIVE AND PREVENTIVE ACTION (CAPA) PLAN. THEREFORE, THIS ISSUE WILL BE MONITORED THROUGH THE POST MARKET SURVEILLANCE ACTIVITIES.

Additional Manufacturer Narrative · 0

INITIAL AND FINAL MDR (B)(4) DEVICE 1 OF 5.

Description of Event or Problem · 0

TO DATE NO ADDITIONAL PATIENT OR EVENT DETAILS HAVE BEEN RECEIVED.

Description of Event or Problem · 0

REFERENCE NUMBER (B)(4). EVENT OCCURRED IN FRANCE. IT WAS REPORTED THAT THE PATIENT FACED INFUSION SET LEAKAGE EVENT ON (B)(6) 2025. THE LEAKAGE WAS BETWEEN THE TUBE AND THE CARTRIDGE. NO FURTHER INFORMATION AVAILABLE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2610888 CONTACT DETACH UNO CONTACT DETACH G29 80/8TCAP 10PK INT FPA UNOMEDICAL UM-D 1002836 6011130

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown