MAUDE MDR 9641304

MDR report key
9641304
Report number
1018233-2020-00574
Event key
0
Event type
3
Date received
2020-01-29
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
3
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
YONIC ANDERSON
Address
8195 INDUSTRIAL BLVD COVINGTON GA 30014 US
Phone
770-770-7707
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1URINE COLLECTIONDRAIN BAGC.R. BARD, INC. (COVINGTON) -1018233KNXUNKUNKR N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12020-01-290

Event Narratives#

N

Patient 1

THE INVESTIGATION IS STILL IN PROGRESS. ONCE THE INVESTIGATION IS COMPLETE, A SUPPLEMENTAL REPORT WILL BE FILED. THE DEVICE WAS NOT RETURNED.

D

Patient 1

IT WAS REPORTED THAT THE DRAIN BAG WAS NOT DRAINING PROPERLY. THE COMPLAINANT REPORTED THAT THEY HAD TO "REALLY WORK THE TUBING" IN ORDER TO GET IT TO DRAIN.