BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ULTRATHANE MAC-LOC LOCKING LOOP MULTIPURPOSE DRAINAGE CATHETER

    MDR report key: 24180236 · Received January 26, 2026

    Report

    Report Number
    1820334-2026-00082
    Event Type
    Malfunction
    Date Received
    January 26, 2026
    Date of Event
    January 19, 2026
    Report Date
    January 26, 2026
    Manufacturer
    COOK INC
    Product Code
    FGE
    UDI-DI
    00827002095045
    PMA / PMN Number
    K173035
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CN
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 0

    D2A: COMMON DEVICE NAME: ADDITIONAL NAMES: GBO CATHETER, NEPHROSTOMY, GENERAL & PLASTIC SURGERY; LJE CATHETER, NEPHROSTOMY. D2B: PROCODE: ADDITIONAL PRODUCT CODES: GBO, LJE. E1: CUSTOMER (PERSON): PHONE: (B)(6). H3: DEVICE EVALUATED BY MFG? DEVICE EVALUATION IS ANTICIPATED BUT HAS NOT YET BEGUN. THIS REPORT INCLUDES INFORMATION KNOWN AT THIS TIME. A FOLLOW-UP REPORT WILL BE SUBMITTED SHOULD ADDITIONAL RELEVANT INFORMATION BECOME AVAILABLE. THIS REPORT IS REQUIRED BY THE FDA UNDER 21 CFR PART 803 AND IS BASED ON UNCONFIRMED INFORMATION SUBMITTED BY OTHERS. NEITHER THE SUBMISSION OF THIS REPORT NOR ANY STATEMENT CONTAINED HEREIN IS INTENDED TO BE AN ADMISSION THAT ANY COOK DEVICE IS DEFECTIVE OR MALFUNCTIONED OR THAT A DEATH OR SERIOUS INJURY OCCURRED; NOR IS IT ADMISSION THAT ANY COOK DEVICE CAUSED, CONTRIBUTED TO, OR IS LIKELY TO CAUSE OR CONTRIBUTE TO A DEATH OR SERIOUS INJURY IF A MALFUNCTION OCCURRED.

    Description of Event or Problem · 0

    IT WAS REPORTED THAT AN ULTRATHANE MAC-LOC LOCKING LOOP MULTIPURPOSE DRAINAGE CATHETER WAS TORN. WHEN THE CATHETER WAS RINSED WITH SALINE, A CRACK AT THE FIRST SIDE PORT OF THE PIGTAIL WAS DISCOVERED. A NEW-LIKE DEVICE FROM A DIFFERENT LOT WAS OBTAINED TO SUCCESSFULLY COMPLETE THE PROCEDURE. AS REPORTED, THE PATIENT DID NOT EXPERIENCE ANY ADVERSE EFFECTS OR REQUIRE ANY ADDITIONAL PROCEDURES DUE TO THIS OCCURRENCE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    246602 ULTRATHANE MAC-LOC LOCKING LOOP MULTIPURPOSE DRAINAGE CATHETER FGE STENTS, DRAINS AND DILATORS FOR THE BILIARY DUCTS FGE COOK INC G09504 16382828 00827002095045

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Unknown