MAUDE MDR 4190392

MDR report key
4190392
Report number
3009211636-2014-00122
Event key
0
Event type
3
Date of event
2013-06-22
Date received
2014-10-21
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
LAWRENCE ROCK
Address
15 HAMPHIRE STREET MANSFIELD MA 02048 US
Phone
508-508-5082
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
13856LF TED STKG NYL T/L LLTED STOCKINGCOSTA RICAFQL3856LF3856LF* N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12014-10-2101. H

Event Narratives#

D

Patient 1

IT WAS REPORTED TO COVIDIEN ON (B)(6) 2014 THAT A CUSTOMER HAD AN ISSUE WITH A TED STOCKING. THE CUSTOMER STATES A PATIENT WAS HOSPITALIZED IN A CARE UNIT FOR A SURGERY ON (B)(6) 2013. THE PATIENT WAS WEARING ANTI-EMBOLIC STOCKINGS IN COMBINATION WITH A COMPRESSION SEQUENTIAL DEVICE AS RECOMMENDED IN PREVENTION OF THROMBOPHLEBITIS. THE DAY AFTER THE SURGERY, THE PATIENT PRESENTED THE FOLLOWING SYMPTOMS: LOSS OF SENSITIVITY TO THE ANKLE, LEFT FOOTDROP DUE TO THE COMPRESSION OF THE COMMON PERONEAL NERVE AND HEMATOMAS IN THE TWO LEGS WERE OBSERVED SUBSEQUENTLY. THE SALES REP CONFIRMED SHE WAS NEVER NOTIFIED OF THIS COMPLAINT AND SHE IS TRYING TO OBTAIN ADDITIONAL INFORMATION WITH THE CUSTOMER.

N

Patient 1

AN INVESTIGATION IS CURRENTLY UNDERWAY. UPON COMPLETION, THE RESULTS WILL BE FORWARDED.

N

Patient 1

THE MANUFACTURING LOT NUMBER ASSOCIATED WITH THIS COMPLAINT WAS NOT PROVIDED. WITHOUT THE LOT NUMBER, A DEVICE HISTORY RECORD (DHR) REVIEW COULD NOT BE PERFORMED. ALL DHRS ARE REVIEWED FOR ACCURACY PRIOR TO PRODUCT RELEASE. THE COMPLAINT SAMPLE WAS NOT RETURNED TO THE MANUFACTURING SITE FOR REVIEW. WITHOUT THE SAMPLE, IT IS NOT POSSIBLE TO DETERMINE A CONFIRMED ROOT CAUSE OF THIS ISSUE. SHOULD THE SAMPLE BE RETURNED IN THE FUTURE, THIS COMPLAINT WILL BE RE-OPENED FOR FURTHER INVESTIGATION. COMPLAINT TRENDING INFORMATION IS BEING REVIEWED ON A MONTHLY BASIS AND IF A TREND IS OBSERVED, ACTIONS WILL BE TAKEN AS NECESSARY. IT MUST BE NOTED THAT IN-PROCESS CONTROLS (SUCH AS PERSONNEL TRAINING, INCOMING QUALITY ACCEPTANCE TESTING FOR RAW MATERIAL, 100% IN PROCESS VISUAL INSPECTION AND VISUAL ACCEPTANCE SAMPLING) ARE IN PLACE TO PREVENT NONCONFORMING PRODUCT FROM LEAVING THE MANUFACTURING OPERATIONS. THIS INFORMATION WILL BE UTILIZED FOR TRACKING AND TRENDING PURPOSES TO DETERMINE THE NEED FOR CORRECTIVE ACTION.