MAUDE MDR 2772651

MDR report key
2772651
Report number
1423537-2012-00038
Event key
0
Event type
3
Date of event
2012-09-11
Date received
2012-10-04
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
2
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MICHELE DONATICH
Address
1430 WAUKEGAN ROAD MCGAW PARK IL 60085 US
Phone
847-847-8478
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1GLV EXAM ESTEEM SYN PF(VYL) LGGLOVE, PATIENT EXAMINATION, VINYLCARDINAL HEALTHLYZ88831P09N052R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12012-10-0401. O

Event Narratives#

N

Patient 1

THE DEVICE HISTORY RECORD OF THE REPORTED LOT NUMBER WAS REVIEWED, AND NO ABNORMALITIES WERE NOTED. HISTORICAL TRENDING WAS DONE. ONE BOX OF GLOVES WAS RECEIVED AS THE SAMPLE, AND THE WATER TEST WAS DONE. NO ABNORMALITIES WERE FOUND ON THE RETURNED GLOVES. WE ARE UNABLE TO IDENTIFY THE POTENTIAL ROOT CAUSE. SINCE THE REPORTED COMPLAINT OF BLOOD CONTAMINATION IMPLIES THAT A HOLE MAY HAVE DEVELOPED DURING OR AFTER USE, THE PROBABLE CAUSE OF THE HOLE MAY BE DUE TO A DIRTY OR WORN OFF FORMER. THE MANUFACTURER HAS BEEN APPRISED OF THIS COMPLAINT FOR CLOSE MONITORING OF THE MANUFACTURING PROCESS. THE MANUFACTURING TEAM HAS TAKEN ACTION BY CLEANING THE FORMERS AND REMOVING WORN OFF FORMERS. WE WILL CONTINUE TO MONITOR COMPLAINTS FOR ANY TRENDS.

N

Patient 1

(B)(6) IS FILING THIS INITIAL MEDWATCH AS THE IMPORTER. THE COMPLAINT WAS FORWARDED TO THE PLANT FOR INVESTIGATION. THE ACTUAL SAMPLE IS NOT AVAILABLE, HOWEVER THE CUSTOMER STATES THAT THEY CAN PROVIDE REPRESENTATIVE SAMPLES. ONCE THE REPRESENTATIVE SAMPLES ARE RECEIVED, THEY WILL BE FORWARDED TO THE PLANT FOR INVESTIGATION. WHEN THEIR INVESTIGATION IS COMPLETED, A FOLLOW UP MEDWATCH WILL BE FILED.

D

Patient 1

NURSE GOT A PATIENT'S BLOOD ON HER GLOVE. WHEN SHE REMOVED THE GLOVE, THE BLOOD WAS ON HER HAND. THE PATIENT WAS DIAGNOSED WITH A BLOODBORNE INFECTIOUS DISEASE PRIOR TO THIS HOSPITALIZATION. NURSE SOUGHT MEDICAL TREATMENT. A PHYSICIAN INSPECTED HER HAND FOR ANY CUTS/SCRATCHES/OPEN WOUNDS (THERE WERE NONE). BASELINE LABS WERE DRAWN, AND SHE WILL HAVE 3 MONTH AND 6 MONTH TESTING. SHE IS DOING FINE NOW.