MELKER EMERGENCY CRICOTHYROTOMY CATHETER SET G07546 C-TCCS-400-TT

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2018-03-28 for MELKER EMERGENCY CRICOTHYROTOMY CATHETER SET G07546 C-TCCS-400-TT manufactured by Cook Inc.

Event Text Entries

[103946389] This mdr is being filed after the associated complaint was reviewed under remediation protocol (b)(4), 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


[103946390] It was reported that when the user picked up the syringe from the melker emergency cricothyrotomy catheter set after opening the package, they found the plunger of the proximal end was broken. They replaced it with another one from their stock, and the device did not make patient contact. There were no injuries or additional procedures.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1820334-2018-00897
MDR Report Key7378796
Date Received2018-03-28
Date of Report2018-03-28
Date of Event2016-11-16
Date Mfgr Received2018-03-23
Device Manufacturer Date2015-10-13
Date Added to Maude2018-03-28
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMR. LARRY POOL
Manufacturer Street750 DANIELS WAY
Manufacturer CityBLOOMINGTON IN 47404
Manufacturer CountryUS
Manufacturer Postal47404
Manufacturer Phone8128294891
Single Use3
Previous Use Code3
Event Type3
Type of Report0

Device Details

Brand NameMELKER EMERGENCY CRICOTHYROTOMY CATHETER SET
Generic NameBWC NEEDLE, EMERGENCY AIRWAY
Product CodeBWC
Date Received2018-03-28
Model NumberG07546
Catalog NumberC-TCCS-400-TT
OperatorHEALTH PROFESSIONAL
Device AvailabilityY
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerCOOK INC
Manufacturer Address750 DANIELS WAY BLOOMINGTON IN 47404 US 47404


Patients

Patient NumberTreatmentOutcomeDate
10 2018-03-28

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