MAUDE MDR 2251036

MDR report key
2251036
Report number
3006760724-2011-00049
Event key
0
Event type
3
Date of event
2011-06-03
Date received
2011-09-16
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
MR TERRY MCMAHON
Address
970 LAKE CARILLON DRIVE SUITE 110 ST. PETERSBURG FL 33716 US
Phone
727-727-7273
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1UNI-SOLVE WIPESSOLVENT, ADHESIVE TAPESMITH & NEPHEW WOUND MANAGEMENTKOX4023000K209R Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12011-09-1601. H

Event Narratives#

N

Patient 1

SUPPLEMENT 002 TO PROVIDE ADDITIONAL INFORMATION OF CUSTOMER REPORTING SUBSEQUENT DEATH: INITIAL MDR WAS FILED ON (B)(4) 2011, AND SUPPLEMENT REPORT 001 CONTAINING THE RESULTS OF OUR INVESTIGATION WAS FILED ON (B)(4) 2011. UPON A RECENT REVIEW OF THE COMPLAINT FILE AND ASSOCIATED MDR DOCUMENTATION IT WAS NOTED THAT THIS SUBSEQUENT INFORMATION REGARDING THE PATIENT DEATH HAD NOT BEEN REPORTED IN OUR INITIAL SUPPLEMENT 001. ON (B)(4) 2011, THE CUSTOMER CONTACTED SMITH & NEPHEW TO INFORM US THAT HER HUSBAND HAD DIED ON OR AROUND (B)(6) 2011. FURTHER COMMUNICATIONS WITH THE CUSTOMER'S WIFE ON (B)(6) 2011, INDICATED THE CAUSE OF DEATH TO BE CANCER. AS THE CAUSE OF DEATH WAS CANCER, THERE WILL BE NO CHANGE TO OUR INITIAL INVESTIGATION REPORTED IN SUPPLEMENT REPORT 001 WHICH STATED THE FOLLOWING: THE CUSTOMER SENT IN SOME PRODUCT SAMPLES. WE WERE UNABLE TO CONFIRM THE COMPLAINT BASED ON INSPECTION OF THE RETURNED SAMPLES, HENCE LABORATORY TESTING WAS PERFORMED. THE RETURNED SAMPLE(S) OF LOTS 0M151, 0K209 AND 0F239 AS WELL AS CONTROL SAMPLES (FROM STOCK) AND OTHER RETURN SAMPLES OF LOTS 0M151, 0K209 AND 0F239 WERE ANALYZED BY AN INDEPENDENT TEST LABORATORY AND MET FINISHED PRODUCT SPECIFICATIONS WITH NO EVIDENCE OF ANY OBJECTIONABLE OR PATHOGENIC MICROBIAL ORGANISMS FOUND. BATCH RECORDS FOR THE LOTS INDICATE ALL SPECIFICATIONS WERE MET AT THE TIME OF RELEASE AND NO INCONSISTENCIES WERE NOTED. AN INDEPENDENT MEDICAL REVIEW CONCLUDED THERE WAS NO CORRELATION BETWEEN THE REPORTED SYMPTOMS AND THE USE OF UNI-SOLVE WIPES. NO FURTHER INVESTIGATION WILL BE PERFORMED AT THIS TIME.

N

Patient 1

THE CUSTOMER SENT IN SOME PRODUCT SAMPLES. WE WERE UNABLE TO CONFIRM THE COMPLAINT BASED ON INSPECTION OF THE RETURNED SAMPLES, HENCE LABORATORY TESTING WAS PERFORMED. THE RETURNED SAMPLE(S) OF LOTS 0M151, 0K209 AND 0F239 AS WELL AS CONTROL SAMPLES (FROM STOCK) AND OTHER RETURN SAMPLES OF LOTS 0M151, 0K209 AND 0F239 WERE ANALYZED BY AN INDEPENDENT TEST LABORATORY AND MET FINISHED PRODUCT SPECIFICATIONS WITH NO EVIDENCE OF ANY OBJECTIONABLE OR PATHOGENIC MICROBIAL ORGANISMS FOUND. BATCH RECORDS FOR THE LOTS INDICATE ALL SPECIFICATIONS WERE MET AT THE TIME OF RELEASE AND NO INCONSISTENCIES WERE NOTED. AN INDEPENDENT MEDICAL REVIEW CONCLUDED THERE WAS NO CORRELATION BETWEEN THE REPORTED SYMPTOMS AND THE USE OF UNI-SOLVE WIPES.

D

Patient 1

THIS UNISOLVE COMPLAINT WAS RECEIVED POST SMITH & NEPHEW'S REMEDIAL ACTION (VOLUNTARY RECALL) TO PREVENT AN UNREASONABLE RISK OF SUBSTANTIAL HARM TO THE PUBLIC HEALTH (REF. RECALL #3006760724-04-06-2011-001R). PATIENT'S WIFE STATES HER HUSBAND WAS AN INPATIENT FOR 10 DAYS. PATIENT'S WIFE STATES HER HUSBAND'S SYMPTOMS: FLEXIBLE TEMPERATURES, HIGH HEART RATE, SPASMS IN ABDOMEN AREA AND REDNESS ON HER HUSBAND'S BELLY AREA. PATIENT WAS DIAGNOSED WITH HAVING THREE BACTERIAL INFECTIONS: GRAM POSITIVE, GRAM NEGATIVE AND GRAM (UNKNOWN NAME).

N

Patient 1

MEDICAL ADVISOR'S REVIEW CONCLUDED THAT THERE IS NO MEDICAL EVIDENCE TO SUPPORT ANY RELATIONSHIP BETWEEN THE USE OF UNISOLVE WIPES AND THIS PATIENT'S SYMPTOMS. ACTIVE INVESTIGATION IN PROGRESS; RESULTS OF INVESTIGATION WILL BE PROVIDED IN A SUPPLEMENT REPORT. (B)(4)