MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor,foreign,other report with the FDA on 2019-01-14 for PIVET GUIDE EMBRYO TRANSFER SET G30457 K-PETS-5000 manufactured by Cook Inc.
[133330738]
(b)(6). 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
[133330739]
It was reported that during an embryo transfer procedure using a pivet guide embryo transfer set, and unknown oily liquid was found in the inner catheter when using it to absorb the embryo. The inner catheter was flushed, and the oily liquid was still present after flushing. It is unknown how the procedure was completed after this difficulty. No adverse events have been reported as a result of the alleged malfunction. Additional information has been requested regarding the patient and the event. At the time of this report, no further information has been provided.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1820334-2019-00042 |
| MDR Report Key | 8243860 |
| Report Source | DISTRIBUTOR,FOREIGN,OTHER |
| Date Received | 2019-01-14 |
| Date of Report | 2019-09-24 |
| Date of Event | 2019-01-07 |
| Date Mfgr Received | 2019-09-20 |
| Device Manufacturer Date | 2018-08-22 |
| Date Added to Maude | 2019-01-14 |
| 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 | PIVET GUIDE EMBRYO TRANSFER SET |
| Generic Name | MQF CATHETER, ASSISTED REPRODUCTION |
| Product Code | MQF |
| Date Received | 2019-01-14 |
| Returned To Mfg | 2019-01-31 |
| Model Number | G30457 |
| Catalog Number | K-PETS-5000 |
| Lot Number | 9016330 |
| 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 | 2019-01-14 |