DEROYAL A131056

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 A131056 manufactured by Deroyal Guatemala.

Event Text Entries

[3711512] Abdominal binder caused itching and rash. Rash light pink without blisters. Rash was all over the area where binder was touching skin. This facility has had more than 7 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 pts 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 a vaginal delivery. Also, staff has stated in previous incidents hat the rash occurs on areas which does not have the skin prep but does have contact with the binder. Pts with and without known allergies have been affected. The manufacturer has been notified. We checked with our surgical unit because they use quite a few abdominal binders nd they have not heard of any concerns regarding rash. Patients in the surgical unit would have similar use of this device. Also, there are pts in the surgical unit who have and who have not had exposure to the same brand of skin prep as the pts on the other 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


[11067958] 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 Number3005225477-2013-00016
MDR Report Key3300841
Report Source06
Date Received2013-08-09
Date of Report2013-07-17
Date of Event2013-07-05
Date Facility Aware2013-07-05
Report Date2013-07-17
Date Reported to FDA2013-07-09
Date Reported to Mfgr2013-07-17
Date Mfgr Received2013-07-17
Device Manufacturer Date2013-05-01
Date Added to Maude2013-09-03
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 VILL CANALES
Manufacturer CityGUATEMLA
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 NumberA131056
Lot Number31622021
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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