UNOMETER SAFETI PLUS - WITH LUER-LOCK AND LUER 158101210190

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 01,05,06,foreign,health profe report with the FDA on 2015-06-01 for UNOMETER SAFETI PLUS - WITH LUER-LOCK AND LUER 158101210190 manufactured by Unomedical Ltd..

Event Text Entries

[5930750] It was reported that during sampling from the urinometer the 'urine flowed too fast in several directions and with the slightest movement there was an important retrograde flow, even if the clamp is closed'. No patient consequences were reported as a result of this event.
Patient Sequence No: 1, Text Type: D, B5


[13416405] Based on the available information, this event is deemed a reportable malfunction. There were no reports of the patient being harmed as a result of this malfunction. Additional patient/event details have been requested. Should additional information become available, a follow-up report will be submitted. This complaint involves five devices, therefore a separate fda form 3500a will be drafted for each device.
Patient Sequence No: 1, Text Type: N, H10


[58367066] Additional information was received regarding the complaint details on june 04, 2015; the date may 08, 2015 is the date in which the follow up form was completed. The awareness date of the complaint is april 08, 2015. The complaint was reported within 24 hours after received. The complaint was received on april 08, 2015 and submitted to world wide product surveillance on april 09, 2015. This is part of record from 6/2015 from (b)(6) related to the unometer safeti plus system. How long the product was used by or on the patient is unknown and is not retrievable. Information of the patient was not provided and is not retrievable. Additional information was received on june 09, 2015 regarding the explanation of aware dates; "the initial report date was april 08, 2015 because the institution did not report the issues to convatec's officer until that date. Initially the institution informed all issues in one report, which were submitted to world wide product surveillance on april 09, 2015 (one day after the aware date). Further in the follow-up answer of may 08, 2015 they informed us that the report they had sent did not correspond to 1 event but to 5 events, which occurred 2 on (b)(6), 1 on (b)(6), 1 on (b)(6) and 1 on (b)(6). " "therefore we were aware of the issues with the device on april 08, 2015 but it was only until may 08, 2015 when we were informed that there were separate events and also of the dates of the events. Therefore you didn't receive this information before because the institution did not provide it to us before either. " additional information was received on june 11, 2015 indicating that the lot # 655189 is associated to icc code/product (b)(4). No additional patient/event details have been provided to date. Should additional information become available, a follow-up report will be submitted.
Patient Sequence No: 1, Text Type: N, H10


[58476206] A quality complaint investigation was performed. After detailed batch review, no discrepancies (includes non- conformances/deviations) were found. A non-conformance for a previous event was opened. The investigation concludes the root cause for the issue cannot be identified on the basis of available information. No further actions are required, and the complaint will be closed. No additional patient/event details have been provided to date. Should additional information become available, a follow-up report will be submitted.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number3007966929-2015-00048
MDR Report Key4810773
Report Source01,05,06,FOREIGN,HEALTH PROFE
Date Received2015-06-01
Date of Report2015-05-08
Date of Event2015-01-26
Date Mfgr Received2015-05-08
Date Added to Maude2015-06-22
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMATTHEW WALENCIAK, INTERIM ASSOC.
Manufacturer Phone9083779293
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameUNOMETER SAFETI PLUS - WITH LUER-LOCK AND LUER
Product CodeEXR
Date Received2015-06-01
Model Number158101210190
Lot Number655189
Device Expiration Date2018-06-01
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerUNOMEDICAL LTD.
Manufacturer AddressZAVODSKAYA STREET 50 FANIPOL DZERZHINSK DISTRICT MINSK REGION 222750 BO 222750


Patients

Patient NumberTreatmentOutcomeDate
10 2015-06-01

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