MAUDE MDR 5904800

MDR report key
5904800
Report number
1018120-2016-00115
Event key
0
Event type
3
Date received
2016-08-25
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
EDWARD ALMEIDA
Address
15 HAMPSHIRE STREET MANSFIELD MA 02048 US
Phone
508-508-5084
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1VISTEC SPG 4X4 STR 10S 16 PLYGAUZE SPONGECOVIDIENEFQ7317731716B071762Y Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12016-08-250

Event Narratives#

N

Patient 1

AN INVESTIGATION IS CURRENTLY UNDER WAY. UPON COMPLETION THE RESULTS WILL BE FORWARDED.

D

Patient 1

IT WAS REPORTED TO COVIDIEN ON (B)(6) 2016 THAT A CUSTOMER HAD AN ISSUE WITH A GAUZE PAD. THE CUSTOMER STATES THE OR STAFF ARE NOTICING THE GAUZE ARE FALLING APART AND LITTLE PIECES ARE FALLING OFF THE GAUZE.

N

Patient 1

THE DEVICE HISTORY RECORD (DHR) FOR LOT 16B071762 INDICATES THAT THERE WERE NO DEFECTS DETECTED IN THE 80 SAMPLES INSPECTED THAT WENT INTO THIS LOT. THERE WERE FIVE SAMPLES IN SEALED PACKAGES OF PRODUCT CODE 7317 RETURNED WITH THIS COMPLAINT. EACH SEALED PACKAGE CONTAINED ONE BUNDLE OF BANDED VISTEC ELEMENT SPONGES. WHEN THE BUNDLE WAS REMOVED FROM THE PACKAGE AND SLIGHTLY SHAKEN, SHORT FIBERS FELL FROM THE SPONGE. A REVIEW OF THE PHOTOS THAT WAS SUBMITTED WITH THE COMPLAINT WAS PERFORMED. ONE PHOTO SHOWED THE LINTING FROM AN UNFOLDED USED SPONGE. THE REPORTED CONDITION IS CONFIRMED. A POTENTIAL ROOT CAUSE FOR THE REPORTED CONDITION IS DURING THE CUTTING PROCESS FIBERS WERE LOOSENED FROM THE SPONGE. THIS COULD LEAD TO PIECES OF COTTON TO FALL FROM THE SPONGE. THIS PRODUCT IS NOT INTENDED TO BE UNFOLDED. 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. THE LOT IS VISUALLY INSPECTED FOR LINTING CONTAMINATION. THE RETURNED PRODUCT WOULD NOT MEET QUALITY SPECIFICATION IN ITS CURRENT STATE. A FORMAL CORRECTIVE AND PREVENTATIVE ACTION (CAPA) WAS OPENED BECAUSE OF LINTING/SHORT FIBERS AND IS CURRENTLY IN OPEN INVESTIGATION. THE CORRECTIVE ACTION PLAN FOR THIS CAPA IS TO: DEVELOP A PROCESS TO MEASURE THE AMOUNT OF SHORT FIBERS PER SPONGE; INSTALL A SYSTEM TO SIGNIFY IF THE VACUUM IS WORKING ON THE TENTER AND IS AT THE ON POSITION; INCREASE THE AMOUNT OF SUCTION ON THE TENTER VACUUMS; CREATE A SYSTEM TO MAKE SURE ALL KNIFE ASSEMBLIES IN PROCESS DESCRIBED ARE ALIGNED PROPERLY BEFORE THE CUTTING PROCESS. 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.