MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05,06,07 report with the FDA on 2015-02-26 for HUDSON CIRCUIT, NEONATAL, DUAL HTD LIMB W/DUAL W 780-15 manufactured by Teleflex Medical.
[20019584]
The customer alleges that the circuit did not pass the leak test. No pt injury.
Patient Sequence No: 1, Text Type: D, B5
[20429194]
Qn # (b)(4). A visual, functional and dimensional inspection of the product involved in the complaint could not be conducted since the product was not returned. No corrective action can be established since the sample is not available to perform an investigation and determine the source of defect reported. Customer complaint cannot be confirmed based only on the info provided, to perform an investigation and determine the source of defect reported, it is necessary to evaluate the sample involved in this complaint. An attempt to duplicate the failure mode was made but at the time there was no inventory of the involved product code available at the facility and it was not being mfg at the time. If device sample becomes available at a later date, this complaint will be re-opened.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 3004365956-2015-00070 |
| MDR Report Key | 4563669 |
| Report Source | 05,06,07 |
| Date Received | 2015-02-26 |
| Date of Report | 2015-02-02 |
| Date of Event | 2015-01-29 |
| Date Mfgr Received | 2015-02-02 |
| Device Manufacturer Date | 2014-03-01 |
| Date Added to Maude | 2015-04-01 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Reporter Occupation | OTHER HEALTH CARE PROFESSIONAL |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | MARGIE BURTON, RN |
| Manufacturer Street | 3015 CARRINGTON MILL BLVD |
| Manufacturer City | MORRISVILLE NC 27560 |
| Manufacturer Country | US |
| Manufacturer Postal | 27560 |
| Manufacturer Phone | 9194334965 |
| Manufacturer G1 | TELEFLEX MEDICAL |
| Manufacturer Street | PARQUE INDUSTRIAL FINSA |
| Manufacturer City | NUEVO LAREDO, TAMAULIPAS 88275 |
| Manufacturer Country | MX |
| Manufacturer Postal Code | 88275 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | HUDSON CIRCUIT, NEONATAL, DUAL HTD LIMB W/DUAL W |
| Generic Name | BREATHING CIRCUIT |
| Product Code | CAG |
| Date Received | 2015-02-26 |
| Catalog Number | 780-15 |
| Lot Number | 02C1400691 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | TELEFLEX MEDICAL |
| Manufacturer Address | RESEARCH TRIANGLE PARK NC US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2015-02-26 |