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 2018-02-16 for QUICK CHECK* H500 STERILIZATION WRAP, 60IN. X 60IN. (152CM X 152CM) 34179 991034179 manufactured by Halyard Health.
[100512776]
The product involved in the report has been returned and is being processed for evaluation. A review of the device history record is in-progress; a follow-up report will be filed. All information reasonably known as of (b)(6) 2018 has been included in this health authority report. Should additional information be obtained, a follow-up health authority report will be provided. The information provided by halyard health represents all of the known information at this time. Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to halyard health. Halyard health has no independent knowledge of the event reported but is relaying the information that was provided by the user facility where the incident occurred. This product incident is documented in the halyard health complaint database and identified as complaint (b)(4).
Patient Sequence No: 1, Text Type: N, H10
[100512777]
It was reported that there was a hole in the material that appeared to look like it was cut with a knife. The user is unsure if there might have been a hole in the material before shipping. It was found after use. No additional information was provided.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1054380-2018-00001 |
| MDR Report Key | 7277965 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2018-02-16 |
| Date of Report | 2018-03-20 |
| Date of Event | 2018-01-25 |
| Date Mfgr Received | 2018-03-20 |
| Date Added to Maude | 2018-02-16 |
| 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 |
| Reporter Occupation | OTHER HEALTH CARE PROFESSIONAL |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MS. LISA CLARK |
| Manufacturer Street | 5405 WINDWARD PARKWAY |
| Manufacturer City | ALPHARETTA GA 30004 |
| Manufacturer Country | US |
| Manufacturer Postal | 30004 |
| Manufacturer Phone | 4704485444 |
| Manufacturer G1 | HALYARD LEXINGTON INC. |
| Manufacturer Street | 389 CLYDE FITZGERALD ROAD |
| Manufacturer City | LINWOOD NC 27299 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 27299 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | QUICK CHECK* H500 STERILIZATION WRAP, 60IN. X 60IN. (152CM X 152CM) |
| Generic Name | KIMGUARD ONESTEP STERILIZATION WRAP |
| Product Code | FRG |
| Date Received | 2018-02-16 |
| Returned To Mfg | 2018-02-12 |
| Model Number | 34179 |
| Catalog Number | 991034179 |
| Lot Number | CO7189LTA |
| Operator | OTHER HEALTH CARE PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | HALYARD HEALTH |
| Manufacturer Address | 5405 WINDWARD PARKWAY ALPHARETTA GA 30004 US 30004 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2018-02-16 |