MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2018-04-06 for EMT AUSTRALIA "MISTAWAY" SOFT PAK REG. FOG EMT-3100 manufactured by Aspen Surgical Products, Caledonia.
[105255755]
Aspen surgical received a report from the distributor indicating that a mistaway sponge was found in the seal of a pouch. The actual device was not returned for evaluation. The manufacturing lot number along with photographic evidence was provided for review. A review of the photo confirmed the issue from the distributor. Analysis of the finished good lot number 133847 was reviewed. No non-conformance's were noted during the manufacturing process. According to the manufacturing process, these parts are manually loaded into recessed pockets on a packaging machine per specified work instructions. If incorrectly loaded or not orientated properly, the product interferes with the sealing process. Therefore a likely root cause for the seal issue may be attributed to an operator error. Production supervisors were notified of this issue. Based on this information, no further action is required.
Patient Sequence No: 1, Text Type: N, H10
[105255756]
Aspen surgical received a report from the distributor indicating that a mistaway sponge was found in the seal of a pouch. The item was not in use. No injury/death was reported. This report was filed in our complaint handling system as (b)(4).
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1836161-2018-00038 |
| MDR Report Key | 7402239 |
| Date Received | 2018-04-06 |
| Date of Report | 2018-03-08 |
| Date of Event | 2018-03-08 |
| Date Mfgr Received | 2018-03-08 |
| Device Manufacturer Date | 2017-05-23 |
| Date Added to Maude | 2018-04-06 |
| 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. JORDAN HACKERT |
| Manufacturer Street | 6945 SOUTHBELT DR. S.E. |
| Manufacturer City | CALEDONIA MI 49316 |
| Manufacturer Country | US |
| Manufacturer Postal | 49316 |
| Manufacturer Phone | 6165367508 |
| Manufacturer G1 | SAME AS ABOVE |
| Manufacturer Country | US |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | EMT AUSTRALIA "MISTAWAY" SOFT PAK REG. FOG |
| Generic Name | ANTI-FOG |
| Product Code | OCT |
| Date Received | 2018-04-06 |
| Model Number | EMT-3100 |
| Lot Number | 133847 |
| Operator | OTHER HEALTH CARE PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ASPEN SURGICAL PRODUCTS, CALEDONIA |
| Manufacturer Address | 6945 SOUTHBELT DR. S.E. CALEDONIA MI 49316 US 49316 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2018-04-06 |