MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05,06 report with the FDA on 1998-07-02 for TEFLON COATED FOLEY CATHETER 8887-653080 manufactured by Kelsar, S.a..
[100260]
Customer reported an eight year old was undergoing an x-ray procedure. During pretest the catheter worked fine. Once the catheter was placed, an experienced clinician could not remove the catheter. First a syringe was used, then the clinician tried cutting. Both were unsuccessful. A cystoscope was performed and the foley was successfully removed.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9610849-1998-00014 |
| MDR Report Key | 175207 |
| Report Source | 05,06 |
| Date Received | 1998-07-02 |
| Date of Report | 1998-06-03 |
| Report Date | 1998-06-03 |
| Date Reported to Mfgr | 1998-06-03 |
| Date Mfgr Received | 1998-06-03 |
| Date Added to Maude | 1998-07-06 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 0 |
| Reporter Occupation | RISK MANAGER |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | TEFLON COATED FOLEY CATHETER |
| Generic Name | FOLEY CATHEER |
| Product Code | FCN |
| Date Received | 1998-07-02 |
| Returned To Mfg | 1998-06-15 |
| Model Number | NA |
| Catalog Number | 8887-653080 |
| Lot Number | 898714 |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | UNKNOWN |
| Device Eval'ed by Mfgr | Y |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 170359 |
| Manufacturer | KELSAR, S.A. |
| Manufacturer Address | BLVD. INSURGENTES PARCELA #37 LA MESA, TIJUANA B.C. MX |
| Baseline Brand Name | PREMIUM TEFLON COATED LATEX FOLEY CATHETER |
| Baseline Generic Name | URINARY DRAIN BAG |
| Baseline Model No | * |
| Baseline Catalog No | 8887-653080 |
| Baseline ID | * |
| Baseline Device Family | UROLOGICAL CATHETER & ACCESSORIES |
| Baseline Shelf Life Contained | * |
| Baseline Shelf Life [Months] | * |
| Baseline PMA Flag | N |
| Baseline 510K PMN | Y |
| Premarket Notification | K810630 |
| Baseline Preamendment | Y |
| Baseline Transitional | N |
| 510k Exempt | N |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 1998-07-02 |