MAUDE MDR 6531890

MDR report key
6531890
Report number
2523676-2017-00064
Event key
0
Event type
3
Date received
2017-04-28
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
MR. JONATHAN SEVERINO
Address
901 MARCON BLVD. ALLENTOWN PA 18109 US
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1PENCAN?SPINAL ANESTHESIA KITB. BRAUN MEDICAL INC.OFU333855R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12017-04-2801. H

Event Narratives#

N

Patient 1

(B)(4). MULTIPLE UNSUCCESSFUL ATTEMPTS WERE MADE TO OBTAIN A SAMPLE AND LOT NUMBER. WITHOUT THE ACTUAL DEVICE AND/OR LOT NUMBER, A THOROUGH INVESTIGATION COULD NOT BE PERFORMED. WHILE WE ARE UNABLE TO CONFIRM THE SPECIFIC NATURE OF THE REPORTED EVENT, B. BRAUN PERFORMED A SEARCH OF OUR COMPLAINT MANAGEMENT DATABASE FROM 27.APR.2011 THRU 27.APR.2017 FOR ALL REGIONAL ANESTHESIA KITS WHERE THERE WAS A REPORTED OCCURRENCE OF MENINGITIS. THE SEARCH IDENTIFIED ONLY ONE (1) PRIOR CASE OF A REPORTED INCIDENT (STREPTOCOCCUS SALIVARIUS) IN 2015 WHICH WAS FULLY INVESTIGATED AND FOUND NOT TO BE RELATED TO ANY DEFECTS OR ISSUES WITH B. BRAUN MANUFACTURED PRODUCT. ADDITIONALLY, THERE HAVE BEEN NO OTHER REPORTS OF THIS NATURE FOR CATALOG ITEM: 333855 "P25SK SPINAL TRAY" OR ASSOCIATED WITH THE SPINAL NEEDLE (B)(4) "PENCAN NEEDLE G25 X 3 ?" UTILIZED WITHIN THE KIT. WE WILL MAINTAIN THIS REPORT FOR FURTHER REFERENCES AND CONTINUE TO MONITOR OTHER REPORTS FOR SIMILAR OCCURRENCES. IF A SAMPLE AND/OR ANY ADDITIONAL PERTINENT INFORMATION BECOMES AVAILABLE, A FOLLOW UP WILL BE SUBMITTED.

D

Patient 1

AS REPORTED BY THE USER FACILITY: THEY HAD A FEMALE PATIENT THAT RECEIVED A LEFT TOTAL HIP REPLACEMENT ON (B)(6) 2017 IN WHICH OUR REF 333855 WAS UTILIZED. PATIENT WAS DISCHARGED HOME AT 1550 ON (B)(6) 2017 WITH NO NOTED COMPLICATIONS. ON (B)(6) 2017, THE PATIENT PRESENTED TO AN ER WITH SUSPECTED BACTERIAL SPINAL MENINGITIS. SPINAL BLOCK PROCEDURE WAS DONE IN THE PRE-OP AREA BY AN EXPERIENCED ANESTHESIOLOGIST WITH NO PRIOR HISTORY OF SUCH COMPLICATIONS. - UNKNOWN WHEN PATIENT SYMPTOMS STARTED. - UNKNOWN HOW DIAGNOSED (IE. SPINAL TAP OR INFLAMMATION NOTED ON CT). - UNKNOWN BACTERIAL STRAIN. LIMITED INFORMATION HAS BEEN PROVIDED AT THIS TIME; SEVERAL ATTEMPTS HAVE BEEN MADE TO OBTAIN ADDITIONAL INFORMATION.

N

Patient 1

(B)(4). MULTIPLE UNSUCCESSFUL ATTEMPTS WERE MADE TO OBTAIN A SAMPLE AND LOT NUMBER. WITHOUT THE ACTUAL DEVICE AND/OR LOT NUMBER, A THOROUGH INVESTIGATION COULD NOT BE PERFORMED. WHILE WE ARE UNABLE TO CONFIRM THE SPECIFIC NATURE OF THE REPORTED EVENT, B. BRAUN PERFORMED A SEARCH OF OUR COMPLAINT MANAGEMENT DATABASE FROM 27.APR.2011 THRU 27.APR.2017 FOR ALL REGIONAL ANESTHESIA KITS WHERE THERE WAS A REPORTED OCCURRENCE OF MENINGITIS. THE SEARCH IDENTIFIED ONLY ONE (1) PRIOR CASE OF A REPORTED INCIDENT (STREPTOCOCCUS SALIVARIUS) IN 2015 WHICH WAS FULLY INVESTIGATED AND FOUND NOT TO BE RELATED TO ANY DEFECTS OR ISSUES WITH B. BRAUN MANUFACTURED PRODUCT. ADDITIONALLY, THERE HAVE BEEN NO OTHER REPORTS OF THIS NATURE FOR CATALOG ITEM: 333855 "P25SK SPINAL TRAY" OR ASSOCIATED WITH THE SPINAL NEEDLE (B)(4) "PENCAN NEEDLE G25 X 3 ?" UTILIZED WITHIN THE KIT. WE WILL MAINTAIN THIS REPORT FOR FURTHER REFERENCES AND CONTINUE TO MONITOR OTHER REPORTS FOR SIMILAR OCCURRENCES. IF A SAMPLE AND/OR ANY ADDITIONAL PERTINENT INFORMATION BECOMES AVAILABLE, A FOLLOW UP WILL BE SUBMITTED.