MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 2006-10-05 for SUR-FIT AUTOLOCK DH FLEXIBLE SKIN BARRIER 401305 manufactured by Convatec.
[19492060]
A type of debris was discovered from the catheter of pt during operation. Although this pt rather tends to have calculus, this debris is not familiar to the doctor.
Patient Sequence No: 1, Text Type: D, B5
[19646444]
Convatec is not certain as to the identity of the debris found in this patient's catheter or if any untoward medical events arose as a result of it. This event is being reported as a due diligence measure while further case investigation and debris analysis continues.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 2243969-2006-00014 |
| MDR Report Key | 861454 |
| Report Source | 05 |
| Date Received | 2006-10-05 |
| Date of Report | 2006-09-05 |
| Date of Event | 2006-09-05 |
| Date Mfgr Received | 2006-09-05 |
| Date Added to Maude | 2007-06-07 |
| 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 | 0 |
| Manufacturer Contact | ADRIENNE MCNALLY |
| Manufacturer Street | 200 HEADQUARTERS PARK DRIVE |
| Manufacturer City | SKILLMAN NJ 08558 |
| Manufacturer Country | US |
| Manufacturer Postal | 08558 |
| Manufacturer Phone | 9089042630 |
| Manufacturer G1 | * |
| Manufacturer Street | * |
| Manufacturer City | * |
| Manufacturer Country | * |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | SUR-FIT AUTOLOCK DH FLEXIBLE SKIN BARRIER |
| Generic Name | OSTOMY WAFER |
| Product Code | EZR |
| Date Received | 2006-10-05 |
| Model Number | NA |
| Catalog Number | 401305 |
| Lot Number | UNK |
| ID Number | NA |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Implant Flag | N |
| Date Removed | * |
| Device Sequence No | 1 |
| Device Event Key | 844427 |
| Manufacturer | CONVATEC |
| Manufacturer Address | 200 HEADQUARTERS PARK DR. SKILLMAN NJ 08558 US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2006-10-05 |