UROPASS AS 12/14FR X 54 CM 5/BX 61254BX

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,user f report with the FDA on 2019-07-15 for UROPASS AS 12/14FR X 54 CM 5/BX 61254BX manufactured by Teleflex Medical Oem.

Event Text Entries

[151009139] User facility reported about the three devices and this is for the third device that was broken into multiple pieces. The device was not returned to the service center for evaluation. The exact cause of the reported event cannot be determined at this time. The instruction manual provides warning and caution statements in an effort to prevent breakage; " do not insert this device without comprehensive knowledge of the indications, techniques, and risks associated with the procedure. Do not insert this device if it has been kinked or damaged prior to use. Replace with undamaged product. Avoid contact with sharp objects as the device can be easily nicked, thereby increasing the potential for breakage.?
Patient Sequence No: 1, Text Type: N, H10


[151009140] The center was informed that during a therapeutic cystoscopy with retrogrades, laser lithotripsy, and stone removal procedure, the sheath was opened by a registered nurse (rn) and passed to surgical technician and then to the sterile field. After the sheath was inserted into the patient it was noted to be broken. A second sheath was then opened and passed to the sterile field. Upon opening this package, it was noted to be broken directly out of the package. Therefore, a third sheath was opened and passed to the sterile field. It was found to be intact, not broken and therefore inserted into the patient. Once inside the patient, it was observed through camera that the sheath had broken into multiple pieces. The sheath was immediately removed from the patient. The surgeon extracted all visualized fragments able to be extracted from the patient. The procedure was completed without the use of the access sheath. There was no patient injury reported. In addition, the user facility reported that materials management was notified and removed remaining items immediately following the case. This is 3 of 3 reports.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number2951238-2019-01009
MDR Report Key8789702
Report SourceCOMPANY REPRESENTATIVE,USER F
Date Received2019-07-15
Date of Report2019-11-06
Date of Event2019-06-18
Date Mfgr Received2019-07-30
Date Added to Maude2019-07-15
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 ContactMS. CONNIE TUBERA
Manufacturer Street2400 RINGWOOD AVENUE
Manufacturer CitySAN JOSE CA 95131
Manufacturer CountryUS
Manufacturer Postal95131
Manufacturer Phone4089355124
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameUROPASS AS 12/14FR X 54 CM 5/BX
Generic NameUROPASS URETERAL ACCESS SHEALTH
Product CodeKYN
Date Received2019-07-15
Returned To Mfg2019-07-03
Model Number61254BX
Lot Number09C1500205
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
Device AgeDA
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerTELEFLEX MEDICAL OEM
Manufacturer Address3750 ANNAPOLIS LN N, SUITE 160 PLYMOUTH MN 55447 US 55447


Patients

Patient NumberTreatmentOutcomeDate
10 2019-07-15

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