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 2018-02-08 for URETHRAL DILATION BALLOON CATHETER G17843 UDBS-090029-FF manufactured by Cook Inc.
[99805617]
(b)(4). This report includes information known at this time. A follow up report will be submitted should additional relevant information become available.
Patient Sequence No: 1, Text Type: N, H10
[99805618]
It was reported upon opening the packaging of the urethral dilation balloon catheter, the balloon was not equipped with the filiform tip. The filiform tip was not in the packaging. The urethra dilatation procedure to treat urethra strictures in a male patient was unable to proceed further because of the missing filiform tip. As reported there were no adverse consequences to the patient.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1820334-2018-00224 |
| MDR Report Key | 7251838 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2018-02-08 |
| Date of Report | 2018-06-08 |
| Date of Event | 2018-01-30 |
| Date Mfgr Received | 2018-06-05 |
| Device Manufacturer Date | 2016-10-04 |
| Date Added to Maude | 2018-02-08 |
| 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 | MR. LARRY POOL |
| Manufacturer Street | 750 DANIELS WAY |
| Manufacturer City | BLOOMINGTON IN 47404 |
| Manufacturer Country | US |
| Manufacturer Postal | 47404 |
| Manufacturer Phone | 8123392235 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | URETHRAL DILATION BALLOON CATHETER |
| Generic Name | KOE DILATOR, URETHRAL |
| Product Code | KOE |
| Date Received | 2018-02-08 |
| Model Number | G17843 |
| Catalog Number | UDBS-090029-FF |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| 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 | 2018-02-08 |