MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2020-01-02 for THAL-QUICK CHEST TUBE SET N/A C-TQTS-1400 manufactured by Cook Inc.
[178332116]
Lot #: unsure, but could be 10019902 or 9991342. (b)(6). Pma/510(k): exempt. 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
[178332117]
It was reported that the catheter of a thal-quick chest tube set had disconnected from the flange while in a patient. The device was inserted into the patient for drainage of pleural effusion. After the disconnection, the catheter was clamped and removed. The hub was connected to a cook thal-quick chest tube adapter and was in place for 5 days. There were no adverse effects experienced as a result of the disconnected because the effusion had cleared and the catheter was already due for removal from the patient that day.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1820334-2020-00015 |
| MDR Report Key | 9538268 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2020-01-02 |
| Date of Report | 2020-01-02 |
| Date of Event | 2019-12-13 |
| Date Mfgr Received | 2019-12-13 |
| Date Added to Maude | 2020-01-02 |
| 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 | THAL-QUICK CHEST TUBE SET |
| Generic Name | GBX CATHETER, IRRIGATION |
| Product Code | GBX |
| Date Received | 2020-01-02 |
| Model Number | N/A |
| Catalog Number | C-TQTS-1400 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| 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 | 2020-01-02 |