MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2018-10-19 for STATLOCK PICC PLUS SLIDING POST PEDIATRIC PAD INCLUDES SKIN PREP N/A VPPPSPCE manufactured by Bard Access Systems.
[124564058]
The device has not been returned to the manufacturer for evaluation. A lot history review (lhr) of juawf135 showed two other similar product complaint(s) from this lot number. The complaints for this lot number (juawf135) have been reported from the same facility in singapore.
Patient Sequence No: 1, Text Type: N, H10
[124564059]
It was reported that the nurse tested devices for dislodged hub casing. It was found that the hub casings on two devices were easy to dislodge. This report addresses the first device.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3006260740-2018-02958 |
| MDR Report Key | 7985671 |
| Date Received | 2018-10-19 |
| Date of Report | 2018-10-19 |
| Date of Event | 2018-09-28 |
| Date Mfgr Received | 2018-09-28 |
| Device Manufacturer Date | 2016-09-01 |
| Date Added to Maude | 2018-10-19 |
| 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 | KELSEY ERICKSON |
| Manufacturer Street | 605 N. 5600 W. |
| Manufacturer City | SALT LAKE CITY UT 84116 |
| Manufacturer Country | US |
| Manufacturer Postal | 84116 |
| Manufacturer Phone | 8015225937 |
| Manufacturer G1 | DAVOL SURGICAL INNOVATIONS -9616067 |
| Manufacturer Street | AVE. ROBERTO FIERRO #6408 PARQUE INDUSTRIAL AEROPUERTO |
| Manufacturer City | CD. JUAREZ, CHIH S.A. DE C.V. 32690 |
| Manufacturer Country | MX |
| Manufacturer Postal Code | 32690 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | STATLOCK PICC PLUS SLIDING POST PEDIATRIC PAD INCLUDES SKIN PREP |
| Generic Name | INTRAVASCULAR CATHETER SECUREMENT DEVICE |
| Product Code | KMK |
| Date Received | 2018-10-19 |
| Model Number | N/A |
| Catalog Number | VPPPSPCE |
| Lot Number | JUAWF135 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BARD ACCESS SYSTEMS |
| Manufacturer Address | 605 N. 5600 W. SALT LAKE CITY UT 84116 US 84116 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2018-10-19 |