BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    INTIMA-II 22GAX1.00IN PRN SLM NPVC

    MDR report key: 8905896 · Received August 19, 2019

    Report

    Report Number
    3006948883-2019-00669
    Event Type
    Malfunction
    Date Received
    August 19, 2019
    Date of Event
    July 30, 2019
    Report Date
    September 18, 2019
    Manufacturer
    BD RAPIS DIAGNOSTICS (SUZHOU) CO. LTD.
    Product Code
    FOZ
    PMA / PMN Number
    N/A
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CH
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 0

    H.6. INVESTIGATION SUMMARY: A DEVICE HISTORY REVIEW WAS CONDUCTED FOR LOT NUMBER 7234049. OUR RECORDS SHOW THAT THIS IS THE ONLY INSTANCE OF THIS ISSUE OCCURRING IN THIS PRODUCTION BATCH. ACCORDING TO THE SAMPLING PLAN APPLIED FOR PRODUCT PERFORMANCE, THIS LOT WAS ACCEPTED AND RELEASED WITHOUT DEFECTS BEING NOTED DURING THE FINAL ASSEMBLY OR VISUAL INSPECTIONS. A SAMPLE COULD NOT BE OBTAINED FOR EVALUATION AND TESTING. WITHOUT THE ABILITY TO INVESTIGATE THE AFFECTED UNIT OUR QUALITY ENGINEERS WERE UNABLE TO DETERMINE THE ROOT CAUSE FOR THIS COMPLAINT.

    Description of Event or Problem · 0

    IT WAS REPORTED THAT THE INTIMA-II 22GAX1.00IN PRN SLM NPVC EXPERIENCED THE CATHETER BACKING OUT OF THE VEIN DURING USE. THE FOLLOWING INFORMATION HAS BEEN PROVIDED BY THE INITIAL REPORTER: IT'S NOTICED THAT THE CATHETER DROPPED AND BROKEN DURING REPLACEMENT PERIOD. ISSUE WAS NOTICED AFTER PATIENT TURN OVER THE BODY.

    Additional Manufacturer Narrative · 1

    A DEVICE EVALUATION IS ANTICIPATED, BUT HAS NOT YET BEGUN. UPON COMPLETION OF THE INVESTIGATION, A SUPPLEMENTAL REPORT WILL BE FILED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE INTIMA-II 22GA X 1.00IN PRN SLM NPVC EXPERIENCED THE CATHETER BACKING OUT OF THE VEIN DURING USE. THE FOLLOWING INFORMATION HAS BEEN PROVIDED BY THE INITIAL REPORTER: IT'S NOTICED THAT THE CATHETER DROPPED AND BROKEN DURING REPLACEMENT PERIOD. ISSUE WAS NOTICED AFTER PATIENT TURN OVER THE BODY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    698739 INTIMA-II 22GAX1.00IN PRN SLM NPVC INTERVASCULAR CATHETER FOZ BD RAPIS DIAGNOSTICS (SUZHOU) CO. LTD. 7234049

    Patients

    Seq Age Sex Outcome Treatment
    1 Other