MAUDE MDR 966072

MDR report key
966072
Report number
1017593-2007-00004
Event key
0
Event type
3
Date of event
2007-04-05
Date received
2007-05-05
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
JIM IRVIN
Address
11775 STARKEY RD LARGO FL 33773 US
Phone
727-727-7273
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1SKIN BOND CEMENTSTOMAL APPLIANCE CEMENTSMITH & NEPHEW INC., WOUND MANAGEMENTEZR400000400000511934NYN

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12007-05-0501. O

Event Narratives#

D

Patient 1

CUSTOMER STATED SHE USES SKIN-BOND TO HOLD HER SON'S INSULIN PUMP IN PLACE, AND THE NEW SKIN-BOND IS NOT HOLDING HIS PUMP ON LIKE THE SKIN-BOND WITH LATEX. THE SKIN-BOND WITH LATEX WOULD ALLOW CHANGES TO HIS INFUSION SITE THREE TIMES PER WEEK. WITH THE NEW BOTTLE OF SKIN-BOND, THEY HAVE BEEN CHANGING HIS SITE 1-2 TIMES DAILY. SHE USES IV PREP WIPES FIRST, USES SKIN-BOND TO PAINT A CIRCLE AROUND THE AREA WHERE SHE WILL INSERT THE CANNULA/PUMP, LETS THE SKIN BOND DRY 3-5 MINUTES, THEN INSERTS THE CANNULA/PUMP. THE CANNULA CAME OUT THE LAST TIME HER SON'S PUMP DISLODGE, BUT HIS BLOOD SUGAR DID NOT INCREASE. HIS CONDITION AT THIS TIME IS EXCELLENT. OUTCOME ATTRIBUTED TO ADVERSE EVENT: CANNULA DISLODGED.

N

Patient 1

EVALUATION SUMMARY: THE LOT RECORD REVIEWED AND HAD NO ANOMALIES OR OUT OF SPECIFICATION CONDITIONS DURING THE PRODUCTION PERIOD AFFILIATED WITH THE CUSTOMER'S CONCERNS. THE LOT MET ALL INSPECTION CRITERIA UPON RECEIPT FROM THE SUPPLIER OF THE ADHESIVE MATERIAL. RETAIN SAMPLES WERE VISUALLY EXAMINED, AND THE PRODUCT WAS WITHIN SPECIFICATION. THE PRODUCT LABEL CONTAINS THE FOLLOWING INFORMATION, "RESULTS MAY VERY DEPENDING ON APPLIANCE USED AND SKIN CONDITION. FOR BEST RESULTS APPLY VERY THIN LAYER ON DRY SKIN." WHEN CUSTOMER REPORTED THIS EVENT, CUSTOMER WAS TOLD NOT TO USE SKIN-BOND ON THE INSULIN PUMP. THIS PRODUCT IS NO LONGER MANUFACTURED OR SOLD BY SMITH & NEPHEW EFFECTIVE FEBRUARY, 2007. NO FURTHER ACTION WILL BE TAKEN AT THIS TIME. HOWEVER, WE WILL CONTINUE TO MONITOR FOR THIS TYPE OF EVENT.