MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2016-04-06 for VISTEC SPG 4X4 NON ST 10S 16PLY 7148 manufactured by Covidien.
[42606506]
An investigation is currently under way. Upon completion the results will be forwarded.
Patient Sequence No: 1, Text Type: N, H10
[42606507]
It was reported to covidien on 03/17 /2016 that the customer had an issue with a gauze sponge. The customer states that when they were assembling the kits and pre-checking the counts on the 4x4's they found that the pack contained only 8 instead of 10.
Patient Sequence No: 1, Text Type: D, B5
[55256001]
The device history record (dhr) for lot 15k037862 indicates that there were no defects found in 80 samples per machine inspected from the lot. One bundle of banded unpackaged vistec element sponges were received for evaluation. Upon physical count of the bundle only 8 sponges were present. The embossed band contained the letter o which identified that the banded sponges were banded together through an off the shelf bander. The reported condition is confirmed. The returned product did not meet quality release specifications for bundle count. Product analysis confirmed that the condition did contribute to the reportable event. A possible root cause may be attributed to the weight count if it was not set up correctly on the autobander. Added variables could have contributed to a weight failure for the scale on the autobanders. The product originates from the manufacturing site and then goes to another source to be used or processed. It is also possible that sponges could have been lost during that process. Prior to a lot? S release, the lot must be deemed acceptable by passing inspections that are based on a valid sampling plan. Inspectors routinely examine a statistical sample both physically and visually. Bundle counts are performed for miscounts per valid sampling plans on each lot produced. A formal corrective and preventative action (capa) was initiated to address the miscount complaints for vistec products. During this capa, the off line banding equipment was discontinued. A reversal of the autobander trays was adjusted to tighten the bands. The capa has been implemented to optimize the autobander process. A rotation of stacked sponges will be removed from the process and validation activities will be performed. This capa is currently in progress. This information will be utilized for trending purposes to determine the need for additional corrective actions. The production department will be notified of this incident with a copy of this complaint response. Finished goods testing are currently being performed at a heightened level for products packaged using banded 10 units for miscount. This heightened testing is performed to ensure containment for the reported condition.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 1018120-2016-00054 |
| MDR Report Key | 5552007 |
| Date Received | 2016-04-06 |
| Date of Report | 2016-03-17 |
| Date of Event | 2016-02-05 |
| Date Mfgr Received | 2016-08-30 |
| Date Added to Maude | 2016-04-06 |
| 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 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | EDWARD ALMEIDA |
| Manufacturer Street | 15 HAMPSHIRE STREET |
| Manufacturer City | MANSFIELD MA 02048 |
| Manufacturer Country | US |
| Manufacturer Postal | 02048 |
| Manufacturer Phone | 5084524151 |
| Manufacturer G1 | COVIDIEN |
| Manufacturer Street | 1430 MARVIN GRIFFIN ROAD |
| Manufacturer City | AUGUSTA GA 30336 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 30336 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | VISTEC SPG 4X4 NON ST 10S 16PLY |
| Generic Name | GAUZE SPONGE |
| Product Code | EFQ |
| Date Received | 2016-04-06 |
| Model Number | 7148 |
| Catalog Number | 7148 |
| Lot Number | 15K037862 |
| Device Availability | Y |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | COVIDIEN |
| Manufacturer Address | 1430 MARVIN GRIFFIN ROAD AUGUSTA GA 30906 US 30906 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2016-04-06 |