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 2018-01-26 for BAKRI TAMPONADE BALLOON CATHETER J-SOS-100500 manufactured by Cook Inc.
[98348224]
(b)(4). This mdr is being filed after the associated complaint was reviewed under remediation protocol cap008, complaint/mdr retrospective review and remediation and reassessed as reportable. Additional complaint investigation and record remediation was not performed.
Patient Sequence No: 1, Text Type: N, H10
[98348225]
It was reported that after insertion of the balloon, it was found to be leaking from a micro-puncture. There were no other balloons available, so the patient required a blood transfusion and transfer to another level of care. There were no other injuries reported, and no pieces of the device remained in the patient's body.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1820334-2018-00269 |
| MDR Report Key | 7221386 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2018-01-26 |
| Date of Report | 2018-01-26 |
| Date of Event | 2015-05-30 |
| Date Mfgr Received | 2018-01-22 |
| Device Manufacturer Date | 2015-03-30 |
| Date Added to Maude | 2018-01-26 |
| 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 Contact | MR. LARRY POOL |
| Manufacturer Street | 750 DANIELS WAY |
| Manufacturer City | BLOOMINGTON IN 47404 |
| Manufacturer Country | US |
| Manufacturer Postal | 47404 |
| Manufacturer Phone | 8128294891 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | BAKRI TAMPONADE BALLOON CATHETER |
| Generic Name | KNA INSTRUMENT, MANUAL, SPECIALIZED OBSTETRIC-GYNECOLOGIC |
| Product Code | KNA |
| Date Received | 2018-01-26 |
| Catalog Number | J-SOS-100500 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | COOK INC |
| Manufacturer Address | 750 DANIELS WAY BLOOMINGTON IN 47404 US 47404 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2018-01-26 |