BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MEDICHOICE

    MDR report key: 3131069 · Received May 23, 2013

    Report

    Report Number
    3003753847-2013-00007
    Event Type
    Injury
    Date Received
    May 23, 2013
    Date of Event
    December 1, 2012
    Report Date
    December 19, 2012
    Manufacturer
    DALIAN GOODWOOD MEDICAL CARE LTD.
    Product Code
    KXF
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Distributor report
    Reporter Location
    CO, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    THE MEDICAL DEVICE ASSOCIATED WITH THIS REPORT IS A NON-STERILE, (B)(4) TIPPED APPLICATOR (OB/GYN) CONSISTING OF A PLASTIC STICK AND THE (B)(4) BUD. IT WAS COMMUNICATED THAT THE APPLICATOR TIP WAS FALLING OFF. THE MANUFACTURER STATED THAT IN JUNE 2011 THEY REDUCED THE CONCENTRATION OF GLUE WHICH WAS USED TO SECURE THE (B)(4) TIP TO THE PLASTIC SHAFT. THE LOW CONCENTRATION OF GLUE USED TO SECURE THE (B)(4) TIP TO THE PLASTIC SHAFT WAS DETERMINED TO BE THE MOST PROBABLE ROOT CAUSE OF THE TIP FALLING OFF.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    230374 MEDICHOICE RAYON TIPPED OB/GYN APPLICATOR KXF DALIAN GOODWOOD MEDICAL CARE LTD. 1206DG13A

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention