PEDI CATH KIT, 5FR, SOFT WITH SURGICAL LUBE CKF155L

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2020-03-17 for PEDI CATH KIT, 5FR, SOFT WITH SURGICAL LUBE CKF155L manufactured by Centurion Medical Prdoucts / Medline Industries, Inc..

Event Text Entries

[184178539] As part of my work related to pt care and supply logistics in a military hosp, i noticed a centurion pediatric catheter kit 5fr soft with surgical lube appeared to have mold and yellow/brown dried liquid on the inside of the package. The package is unopened and not expired; exp date is set for 10/31/2020. I have not opened the packet to investigate, but i believe that the internal packet of iodine was broken and leaked out. This allowed for a growth to start inside the otherwise sterile package. The rest of the lot seemed uncontaminated. The lot number is 2018120690. The reorder number for the centurion medical product is ckf155l. I was recently informed to create this report regarding the event. Fda safety report id#. (b)(4).
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report NumberMW5093804
MDR Report Key9847754
Date Received2020-03-17
Date of Report2020-03-15
Date of Event2020-01-12
Date Added to Maude2020-03-18
Event Key0
Report Source CodeVoluntary report
Manufacturer LinkN
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationUNKNOWN
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NamePEDI CATH KIT, 5FR, SOFT WITH SURGICAL LUBE
Generic NameTRAY, CATHETRIZATION, STERILE URETHRAL WITH OR WITHOUT CATHETER (KIT)
Product CodeFCM
Date Received2020-03-17
Model NumberCKF155L
Lot Number2018120690
Device AvailabilityY
Device Eval'ed by MfgrI
Device Sequence No1
Device Event Key0
ManufacturerCENTURION MEDICAL PRDOUCTS / MEDLINE INDUSTRIES, INC.


Patients

Patient NumberTreatmentOutcomeDate
10 2020-03-17

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