MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a user facility report with the FDA on 2016-09-08 for BARON SUCT TUBE 3 ANG 5FR 385082 manufactured by Integra York, Pa Inc..
[54143948]
On 8/31/2016 integra investigation completed. Method: failure analysis, device history evaluation. Results: failure analysis - a suction tube was returned in used condition, showing an orange tape marking, wear, broken, black staining. While performing the visual inspection of the instrument; it is noticed that in the shaft area there is a hole. It appears this is the area of breakage. There is black staining within the area also. Without knowing how the instrument was handled and how much pressure was used during use, the cause of the complaint is undetermined. The complaint report is confirmed. Device history evaluation - nonconforming product report / nonconforming material report history: none. Variance authorization / deviation history: none. Engineering change order/manufacturing change order history: there is no applicable engineering change order/manufacturing change order history. Corrective action preventive action history/corrections: none. Health hazard evaluation history: none. Conclusion: the root cause has not been identified as a workmanship or material deficiency.
Patient Sequence No: 1, Text Type: N, H10
[54143949]
Customer initially reports the baron suction tube 4 angled 5fr broke at hub during use in surgery. On (b)(6) 2016 customer reports device broke when suctioning nasal cavity, no harm done, no further information available.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2523190-2016-00135 |
| MDR Report Key | 5935345 |
| Report Source | USER FACILITY |
| Date Received | 2016-09-08 |
| Date of Report | 2016-08-10 |
| Date Mfgr Received | 2016-08-10 |
| Device Manufacturer Date | 2015-04-01 |
| Date Added to Maude | 2016-09-08 |
| 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 | USER SANDRA LEE |
| Manufacturer Street | 311 ENTERPRISE DRIVE |
| Manufacturer City | PLAINSBORO NJ 08536 |
| Manufacturer Country | US |
| Manufacturer Postal | 08536 |
| Manufacturer Phone | 6099362393 |
| Manufacturer G1 | INTEGRA YORK, PA INC. |
| Manufacturer Street | 589 DAVIES DRIVE |
| Manufacturer City | YORK PA 17402 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 17402 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | BARON SUCT TUBE 3 ANG 5FR |
| Generic Name | N/A |
| Product Code | JZF |
| Date Received | 2016-09-08 |
| Returned To Mfg | 2016-08-25 |
| Catalog Number | 385082 |
| Lot Number | UNKNOWN |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | INTEGRA YORK, PA INC. |
| Manufacturer Address | 589 DAVIES DRIVE 589 DAVIES DRIVE YORK PA 17402 US 17402 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2016-09-08 |