MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2017-09-26 for TUR IRRIGATION SET ARC4005P manufactured by Baxter Healthcare - Cali.
[87316086]
Initial reporter phone: (b)(6). The device has been received and the evaluation is in progress. Should additional relevant information become available, a supplemental report will be submitted.
Patient Sequence No: 1, Text Type: N, H10
[87316087]
It was reported that a tur irrigation set had a loose connection between the tubing and the connector. This occurred before use. There was no patient involvement. No additional information is available.
Patient Sequence No: 1, Text Type: D, B5
[104200783]
The device was received for evaluation. Visual inspection revealed that the rubber tube was separated from the guide tube. The reported condition was verified. The cause of the condition was determined to be an assembly issue during manufacturing. A nonconformance has been opened to address this issue. A batch review was conducted and there were no deviations found related to this reported condition during the manufacture of this lot. Should additional relevant information become available, a supplemental report will be submitted.
Patient Sequence No: 1, Text Type: N, H10
[104200784]
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1416980-2017-07824 |
| MDR Report Key | 6893260 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2017-09-26 |
| Date of Report | 2017-11-01 |
| Date of Event | 2017-08-28 |
| Date Mfgr Received | 2017-10-20 |
| Device Manufacturer Date | 2017-07-20 |
| Date Added to Maude | 2017-09-26 |
| 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 Street | 25212 W. ILLINOIS ROUTE 120 |
| Manufacturer City | ROUND LAKE IL 60073 |
| Manufacturer Country | US |
| Manufacturer Postal | 60073 |
| Manufacturer Phone | 2242702068 |
| Manufacturer G1 | BAXTER HEALTHCARE - CALI |
| Manufacturer Street | CALLE 36 NO. 2C-22 APARTADO AERO 2446 |
| Manufacturer City | CALI |
| Manufacturer Country | CO |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | TUR IRRIGATION SET |
| Generic Name | SYSTEM, IRRIGATION, UROLOGICAL |
| Product Code | LJH |
| Date Received | 2017-09-26 |
| Returned To Mfg | 2017-09-08 |
| Model Number | NA |
| Catalog Number | ARC4005P |
| Lot Number | SE17GI3 |
| ID Number | NA |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BAXTER HEALTHCARE - CALI |
| Manufacturer Address | CALI |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2017-09-26 |