MAUDE MDR 7318221

MDR report key
7318221
Report number
1320894-2018-00063
Event key
0
Event type
3
Date received
2018-03-06
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MS. LINDSEY SHEPPARD
Address
525 FRENCH ROAD UTICA NY 13502 US
Phone
727-727-7273
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1POOLE SUCTION INSTRUMENT 50/CSURGICAL INSTRUMENTS, STERILECONMED CORPORATIONBYY0035040201607111Y R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12018-03-060

Event Narratives#

N

Patient 1

THE UNUSED DEVICE WAS RETURNED TO CONMED IN ORIGINAL PACKAGING. VISUAL INSPECTION REVEALED A SMALL HOLE ON THE PRODUCT PACKAGING POLY ADJACENT THE MIDDLE OF THE COMPLAINT DEVICE. THIS HOLE RESULTED IN A BREACH OF STERILITY OF THE PRODUCT. DUE TO THE APPEARANCE AND LOCATION OF THE DEFECT AREA, IT NOT LIKELY A MANUFACTURING RELATED ISSUE. THE MANUFACTURING DOCUMENTS FROM THE DEVICE HISTORY RECORD HAVE BEEN REVIEWED WITH SPECIAL ATTENTION TO THE MANUFACTURING AND INSPECTION OF THIS PRODUCT. THE PRODUCTS RELEASED FOR DISTRIBUTION WERE FOUND TO HAVE MET ALL SPECIFICATIONS PRIOR TO SHIPMENT. OF THE LOT CONTAINING (B)(4) UNITS, NO PRIOR COMPLAINTS HAVE BEEN RECEIVED. A TWO-YEAR REVIEW OF COMPLAINT HISTORY REVEALED 19 PRIOR SIMILAR COMPLAINTS. DURING THIS SAME TIME FRAME, (B)(4) DEVICES HAVE BEEN MANUFACTURED AND SHIPPED WORLDWIDE, MAKING THE RATE OF OCCURRENCE OF THIS FAILURE (B)(4). THIS REPORTED PACKAGING ISSUE WAS OBVIOUS TO THE DISTRIBUTOR, PROMPTING THE RETURN OF THE DEVICE FOR EVALUATION. THERE WAS NO PATIENT INVOLVEMENT. AS WITH ALL MEDICAL DEVICES, EXAMINATION OF THE PRODUCT OCCURS MULTIPLE TIMES PRIOR TO USE. GOOD CLINICAL PRACTICE WOULD INCLUDE EXAMINATION AND VERIFICATION OF THE ORIGINAL PACKAGING AND ITS LABELING TO ENSURE BOTH ARE INTACT. THE INSTRUCTIONS FOR USE (IFU) PROVIDES THE FOLLOWING WARNING. IF PACKAGING HAS BEEN OPENED/DAMAGED OR ALTERED, DO NOT USE THE PRODUCT AND CONTACT THE MANUFACTURER IMMEDIATELY. THIS ISSUE WILL CONTINUE TO BE MONITORED THROUGH THE COMPLAINT SYSTEM TO ASSURE PATIENT SAFETY.

D

Patient 1

THE DISTRIBUTOR IN (B)(4) REPORTED A "DAMAGE" ON THE STERILE POUCH OF THIS 0035040 SURGICAL TUBING. THERE WAS NO PATIENT INVOLVEMENT AS THIS DEFECT WAS DISCOVERED DURING INCOMING INSPECTION. THIS REPORT IS RAISED ON THE BASIS OF A STERILITY BREACH FOUND DURING THE DEVICE EVALUATION.