MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2020-03-13 for CWS 400 WOUND SUCTION KIT WITH 10 FRENCH ROUND DRAIN 0043660 manufactured by C.r. Bard, Inc..
[183272113]
When attempting to remove drain from left buttock, the drain tubing broke, leaving a portion of the tubing in the patient's buttock. No bleeding or pain was observed at the site. Scheduled patient for surgery to remove.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9828981 |
| MDR Report Key | 9828981 |
| Date Received | 2020-03-13 |
| Date of Report | 2020-02-21 |
| Date of Event | 2020-02-11 |
| Report Date | 2020-02-21 |
| Date Reported to FDA | 2020-02-21 |
| Date Reported to Mfgr | 2020-03-13 |
| Date Added to Maude | 2020-03-13 |
| Event Key | 0 |
| Report Source Code | User Facility report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 0 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Reporter Occupation | RISK MANAGER |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | CWS 400 WOUND SUCTION KIT WITH 10 FRENCH ROUND DRAIN |
| Generic Name | APPARATUS, SUCTION, SINGLE PATIENT USE, PORTABLE, NONPOWERED |
| Product Code | GCY |
| Date Received | 2020-03-13 |
| Catalog Number | 0043660 |
| Lot Number | NGDQ2620 |
| Device Availability | N |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | C.R. BARD, INC. |
| Manufacturer Address | 8195 INDUSTRIAL BLVD COVINGTON GA 30014 US 30014 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2020-03-13 |