FDA Adverse Event Summary report: N

3500 DRAIN BAG

MDR report key: 5553 · Received April 27, 1993

Report

Report Number
5553
Date Received
April 27, 1993
Report Date
April 5, 1993
Manufacturer
BOSTON PACIFIC MEDICAL, INC.
Product Code
EZL
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

DUE TO AN ERROR IN PACKAGING AT MANUFACTURING FACILITY, THEDRAIN BAG HAS BEEN FOLDED INCORRECTLY IN ITS POLY BAG.THE "FOLD" HAS CAUSED THE ANTI REFLUX DEVICE TO CURL SLIGHTLY, CAUSING A "STANDING COLUMN OF URINE" TO BACK UP IN THE ADJOINING TUBE. THIS PROBLEM IS TEMPORARY.DEVICE LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: INVALID DATA. INVALID DATA - REGARDING MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY. NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. INVALID DATA - WHETHER DEVICE USED AS LABELED/INTENDED. INVALID DATA - REGARDING EVALUATION BY USER AFTER EVENT. METHOD OF EVALUATION: INVALID DATA. RESULTS OF EVALUATION: INVALID DATA. CONCLUSION: INVALID DATA. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: INVALID DATA. CORRECTIVE ACTIONS: NO DATA. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 3500 DRAIN BAG FOLEY CATHETER BAG EZL BOSTON PACIFIC MEDICAL, INC. 3500

Patients

Seq Age Sex Outcome Treatment
1 UNK Invalid Data