MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor,foreign report with the FDA on 2018-12-17 for 1/4" (6.4MM) X 10' (3M) 0036290 manufactured by Consolidated Medical Equipment.
[130628505]
The reported device is expected to be returned to conmed for evaluation. A supplemental and final report will be filed following the completion of the device evaluation and complaint investigation.
Patient Sequence No: 1, Text Type: N, H10
[130628506]
During incoming inspection, the distributor rejected this device, (b)(4) for an insufficient heat seal. There was no contact with the patient as this was found during incoming inspection. Due to the potential severity of a breach in sterility, this complaint meets the criteria for a reportable event. This will be reported as a malfunction with potential for injury upon reoccurrence.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3007305485-2018-00302 |
| MDR Report Key | 8171491 |
| Report Source | DISTRIBUTOR,FOREIGN |
| Date Received | 2018-12-17 |
| Date of Report | 2019-01-11 |
| Date Mfgr Received | 2018-12-19 |
| Device Manufacturer Date | 2018-02-07 |
| Date Added to Maude | 2018-12-17 |
| 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 | MS TRACEY WEISELBENTON |
| Manufacturer Street | 11311 CONCEPT BLVD |
| Manufacturer City | LARGO FL 337734908 |
| Manufacturer Country | US |
| Manufacturer Postal | 337734908 |
| Manufacturer Phone | 7273995557 |
| Manufacturer G1 | CONSOLIDATED MEDICAL EQUIPMENT |
| Manufacturer Street | ALEJANDRO DUMAS AVE, 11321 COMPLEJO INDUSTRIAL CHIHUAHUA |
| Manufacturer City | CHIHUAHUA, MEXICO 31136 |
| Manufacturer Country | MX |
| Manufacturer Postal Code | 31136 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | 1/4" (6.4MM) X 10' (3M) |
| Generic Name | SURGICAL TUBING |
| Product Code | BYY |
| Date Received | 2018-12-17 |
| Returned To Mfg | 2018-12-19 |
| Catalog Number | 0036290 |
| Lot Number | 201802075 |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | CONSOLIDATED MEDICAL EQUIPMENT |
| Manufacturer Address | ALEJANDRO DUMAS AVE, 11321 COMPLEJO INDUSTRIAL CHIHUAHUA CHIHUAHUA, MEXICO 31136 MX 31136 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2018-12-17 |