BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    U BY KOTEX CLICK : TAMPON, MENSTRUAL, UNSCENTED : HEB

    MDR report key: 5698272 · Received June 3, 2016

    Report

    Report Number
    3011112444-2016-00008
    Event Type
    Malfunction
    Date Received
    June 3, 2016
    Date of Event
    May 9, 2016
    Report Date
    May 11, 2016
    Manufacturer
    K-C AFC MANUFACTURING, S. DE R.L. DE C.V (NUEVO NOGALES
    Product Code
    HEB
    PMA / PMN Number
    PK113036
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    A DOCUMENT AND RECORDS REVIEW WAS PERFORMED ON THE REPORTED LOT. DOCUMENTATION ASSESSED INCLUDES: MANUFACTURING, QUALITY AUDIT, PRODUCTION, RAW MATERIAL AND DEVICE HISTORY RECORDS. THIS ASSESSMENT FOUND NO ANOMALIES THAT MAY HAVE ATTRIBUTED TO THE REPORTED ISSUE; THEREFORE THE COMPLAINT COULD NOT BE CONFIRMED. COMPLAINT SAMPLE WAS NOT RETURNED THEREFORE A PRODUCT EVALUATION COULD NOT BE PERFORMED. THE CAUSE OF THE REPORTED COMPLAINT COULD NOT BE DETERMINED. INFORMATION FROM THIS INCIDENT WILL BE INCLUDED IN OUR PRODUCT COMPLAINT AND MDR TREND ANALYSIS.

    Description of Event or Problem · 1

    CONSUMER CALLED TO REPORT A UBK CLICK SUPER TAMPON THAT FELL APART DURING ATTEMPTED REMOVAL. IT APPEARED TO HAVE UNRAVELED AND A PORTION WAS LEFT IN HER VAGINAL CANAL. SHE REMOVED THE REMAINING PIECES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    354267 U BY KOTEX CLICK : TAMPON, MENSTRUAL, UNSCENTED : HEB TAMPON, MENSTRUAL, UNSCENTED HEB K-C AFC MANUFACTURING, S. DE R.L. DE C.V (NUEVO NOGALES SUPER NN605701B1918

    Patients

    Seq Age Sex Outcome Treatment
    1 24 YR