MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,user f report with the FDA on 2018-07-24 for FLEXOR PARALLEL URETERAL ACCESS SHEATH AND DILATORS FUS-107035-P manufactured by Cook Inc.
[114842092]
Date of event: last week of (b)(6) or first week in (b)(6) exact date unknown. 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
[114842093]
It was reported, during a ureteroscopy procedure, stringy material was entering the bladder when the inner dilator of sheath was going through lumen of sheath and protruding from end of sheath of the flexor parallel ureteral access sheath and dilators. A new access sheath was used to complete the procedure. It was reported the stringy material from inside the lumen of the sheath was coming off and being left in the bladder. No adverse events have been reported as a result of the alleged malfunction.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1820334-2018-02142 |
| MDR Report Key | 7714045 |
| Report Source | COMPANY REPRESENTATIVE,USER F |
| Date Received | 2018-07-24 |
| Date of Report | 2018-08-17 |
| Date Mfgr Received | 2018-08-15 |
| Device Manufacturer Date | 2018-04-13 |
| Date Added to Maude | 2018-07-24 |
| 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 |
| Manufacturer G1 | COOK INC |
| Manufacturer Street | 750 DANIELS WAY |
| Manufacturer City | BLOOMINGTON IN 47404 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 47404 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | FLEXOR PARALLEL URETERAL ACCESS SHEATH AND DILATORS |
| Generic Name | KOE DILATOR, URETHRAL |
| Product Code | KOE |
| Date Received | 2018-07-24 |
| Returned To Mfg | 2018-07-25 |
| Catalog Number | FUS-107035-P |
| Lot Number | 8771956 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| 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 | 2018-07-24 |