DEROYAL A131067

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 06 report with the FDA on 2013-08-09 for DEROYAL A131067 manufactured by Deroyal Guatemala.

Event Text Entries

[15782076] Patient developed red, non-raised, rash from abdominal binder that was used post c-section. I spoke with the clinical leader of mother baby unit and labor and delivery and they both stated there has been nothing different in either products or procedures to which they can attribute this type of event (binders causing rash). There have been no change in l and d to the skin prep, dressings, or the operation room packs. The abdominal binders are placed on dry skin in labor and delivery.. This facility has had more than 10 similar events with this product in the last 5 months. Product states latex free. The facility reports this type of reaction has been seen in patients with c-sections as well as vaginal deliveries; thus staff does not believe that there is a reaction to the skin prep used for c-section deliveries because the prep is not used in vaginal delivery. Also, staff has stated in previous incidents that the rash occurs on areas with does not have the skin prep but does have contact with the binder. Patients with and without known allergies have been affected. The manufacturer has been notified. They are unaware of any other complaints like this. We checked with our surgical unit because they use quite a few abdominal binders and they have not heard of any concerns regarding rash. Patients in the surgical unit would have similar use of this device. Also, there are patients in the surgical unit both who have and who have not had exposure to the same brand of skin prep as the patients on the other nursing unit. The storage procedure/process for both nursing units is identical: storage and transportation of the devices are not believed to be contributing factors in these events.
Patient Sequence No: 1, Text Type: D, B5


[15874017] Deroyal: the bill of material for the components of the product was reviewed and no material changes to the components were identified for the lot number reported. Furthermore, the product does not contain natural rubber latex.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number3005225477-2013-00015
MDR Report Key3290261
Report Source06
Date Received2013-08-09
Date of Report2013-07-17
Date of Event2013-07-11
Date Facility Aware2013-07-11
Report Date2013-07-17
Date Reported to FDA2013-07-16
Date Reported to Mfgr2013-07-17
Date Mfgr Received2013-07-17
Device Manufacturer Date2013-04-01
Date Added to Maude2013-08-26
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationRISK MANAGER
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer Street200 DEBUSK LANE
Manufacturer CityPOWELL TN 37849
Manufacturer CountryUS
Manufacturer Postal37849
Manufacturer Phone8659387828
Manufacturer G1DEROYAL GUATEMALA
Manufacturer StreetKM 20.5 CARRETERA A VILLA CANALES
Manufacturer CityVILL CANALES
Manufacturer CountryGT
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameDEROYAL
Generic NameMHW - DRESSING, COMPRESSION
Product CodeMHW
Date Received2013-08-09
Returned To Mfg2013-07-22
Catalog NumberA131067
Lot Number31048058
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
Device AgeDA
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerDEROYAL GUATEMALA
Manufacturer AddressGT


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2013-08-09

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