MAUDE MDR 1343300

MDR report key
1343300
Report number
2183558-2009-00004
Event key
0
Event type
3
Date of event
2009-01-08
Date received
2009-01-29
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
0
Initial report to FDA
0
Event location
0

Manufacturer Contact#

Contact
REBEKA STOLTMAN, MANAGER
Address
1499 WEST RIVER RD N MINNEAPOLIS MN 55411 US
Phone
612-612-6123
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1MCGUIRE URINAL UNISIZEURINE COLLECTORCOLOPLAST MANUFACTURING US, LLCFNP507070140050707014001578320R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12009-01-2901. R

Event Narratives#

D

Patient 1

AN END-USER'S DAUGHTER REPORTED AN ISSUE WITH THE PRODUCT SHE HAD PURCHASED FOR HER FATHER IN EARLY 2009. HE USED IT THAT NIGHT ALONG WITH A BARDIA BAG (PROD. NOT LOT NUMBER AVAILABLE). WHEN HE WOKE UP, THE SHEATH WAS SUCTIONING AROUND THE PENIS SO THAT IT WAS ALMOST COMPLETELY FLATTENED. WHEN THEY REMOVED THE MCGUIRE, THE PENIS WAS SWOLLEN TO ALMOST 3 TIMES THE NORMAL SIZE AND BROKEN BLOOD VESSELS WERE VISIBLE. THERE WAS VERY LITTLE URINE IN THE COLLECTION BAG, BUT PATIENT'S DAUGHTER REPORTED THEY HAD USED THAT EXACT BARDIA BAG FOR 2 WEEKS WITH MECS AND DID NOT HAVE AN ISSUE WITH IT, SO IT DIDN'T APPEAR TO BE A DEFECT IN THE BAG. PATIENT CLAIMS HE IS NOT IN PAIN, BUT MAY DECIDE TO GO TO URGENT CARE IF THE SWELLING DOES NOT GO DOWN. A COMPLAINT WAS FILED AND PATIENT IS SENDING DEFECTIVE PRODUCT BACK.

N

Patient 1

THE RETURN OF THE DEVICE HAS BEEN REQUESTED. IT IS UNKNOWN IF THE DEVICE IS STILL AVAILABLE. WITHOUT THE BENEFIT OF EXAMINATION AND TESTING, COLOPLAST IS PRECLUDED FROM COMMENTING ON THE CONDITION OF THE DEVICE OR THE CAUSE OF THE OCCURRENCE. SHOULD THE DEVICE OR ADDITIONAL INFORMATION BE RECEIVED, AN ADDENDUM TO THIS REPORT WILL BE FILED. TO DATE, NO OTHER COMPLAINTS HAVE BEEN RECORDED FOR THIS LOT NUMBER.