DEROYAL 1140PP

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a consumer report with the FDA on 2018-01-03 for DEROYAL 1140PP manufactured by Ortho And Surgical Products Enterprises S.a..

Event Text Entries

[96212831] A call/complaint was received indicating that the "abdominal binder was applied post op directly next to skin, patient broke out in rash". It was reported that the sample was not available for return. The process records have been checked and no issues were found related to the problem reported. (b)(4) each abdominal binders were inspected from work in process and no issues were found during the inspection. The root cause was unable to be determined, possible patient sensitivity. The abdominal binder is made of polyester, nylon and lycra spandex and is not made with natural rubber latex. There have been no other complaints reported for this finished good product number. Between, november 12, 2015 - december 20, 2017, there has been one report of this malfunction for a percentage of (b)(4) units sold, of this product finished good number 1140pp abdominal binder. No further information is available at this time. We will provide a follow up report if additional information becomes available.
Patient Sequence No: 1, Text Type: N, H10


[96212832] Quality issue details: date of occurrence: (b)(6) 2017. When did quality issue occur? During use. Who was using or operating the product when the quality issue occurred? Patient/end consumer. Was a medical procedure involved? No. Name of medical procedure: not applicable. Did the quality issue cause a delay in the medical procedure? Not applicable. Detailed description of quality issue: abdominal binder was applied post op directly next to skin, patient broke out in rash. Customer wants to know if there are specifications or directives to use binder next to skin or use bandages or cloth between binder and skin. How was the quality issue was identified? By actual use. How was the product being used? Post op c-section. Was it the initial use of the product? Yes. Was the product modified from the original condition supplied by deroyal? No. Was the product connected to or used in conjunction with other devices or equipment? No. Outcome details: outcome(s) attributed to quality issue: irritation, reaction, rash. Details of irritation, reaction, rash (severity, medical treatment, etc. ): no info provided. Person(s) affected by outcome(s) checked above: patient. Known pre-existing condition(s) of person(s) affected: none specified. Was the incident reported to the fda? No. Detailed description of outcome(s), including information regarding injury or any additional treatment/intervention required: end user reported to s2s.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number3010452421-2017-00006
MDR Report Key7159570
Report SourceCONSUMER
Date Received2018-01-03
Date of Report2017-12-08
Date of Event2017-12-08
Date Added to Maude2018-01-03
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional0
Initial Report to FDA0
Report to FDA3
Event Location3
Manufacturer ContactMS. MELISSA LOGSDON
Manufacturer Street200 DEBUSK LANE
Manufacturer CityPOWELL TN 37849
Manufacturer CountryUS
Manufacturer Postal37849
Manufacturer Phone8653626157
Manufacturer G1ORTHO AND SURGICAL PRODUCTS ENTERPRISES S.A.
Manufacturer StreetKM 20.5 CARRETERA A VILLA CANALES
Manufacturer CityVILLA CANALES, GUATEMALA 01065
Manufacturer CountryGT
Manufacturer Postal Code01065
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameDEROYAL
Generic NameABDOMINAL BINDER
Product CodeFSD
Date Received2018-01-03
Model Number1140PP
Device AvailabilityN
Device Eval'ed by MfgrN
Device Sequence No1
Device Event Key0
ManufacturerORTHO AND SURGICAL PRODUCTS ENTERPRISES S.A.
Manufacturer AddressKM 20.5 CARRETERA A VILLA CANALES VILLA CANALES, GUATEMALA 01065 GT 01065


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2018-01-03

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