URODYNAMICS BALLOON CATHETER 020707-B5

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2018-11-29 for URODYNAMICS BALLOON CATHETER 020707-B5 manufactured by Cook Inc.

Event Text Entries

[129593400] 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


[129593401] It was reported that during the use of urodynamics balloon catheter for cystometry studies, the balloon "exploded". It was further noted that the balloon material was split from proximal bond to distal bond. There were no adverse effects reported due to the event and no report of an additional procedure. A new product was used.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1820334-2018-03581
MDR Report Key8116653
Date Received2018-11-29
Date of Report2018-11-29
Date of Event2016-07-18
Date Mfgr Received2018-11-26
Device Manufacturer Date2015-12-11
Date Added to Maude2018-11-29
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
Manufacturer G1COOK INC
Manufacturer Street750 DANIELS WAY
Manufacturer CityBLOOMINGTON IN 47404
Manufacturer CountryUS
Manufacturer Postal Code47404
Single Use3
Previous Use Code3
Event Type3
Type of Report0

Device Details

Brand NameURODYNAMICS BALLOON CATHETER
Generic NameFAP CYTOMETRIC GAS (CARBON DIOXIDE
Product CodeFAP
Date Received2018-11-29
Returned To Mfg2017-05-30
Model NumberNA
Catalog Number020707-B5
Lot Number6447907
Device Expiration Date2018-12-11
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
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 2018-11-29

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