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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: COVIDIEN MFG SOLUTIONS S.A. PALINDROME; CATHETER, HEMODIALYSIS, IMPLANTED

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COVIDIEN MFG SOLUTIONS S.A. PALINDROME; CATHETER, HEMODIALYSIS, IMPLANTED Back to Search Results
Model Number 8888145014
Device Problems Product Quality Problem (1506); Material Integrity Problem (2978)
Patient Problem No Consequences Or Impact To Patient (2199)
Event Date 05/04/2020
Event Type  malfunction  
Manufacturer Narrative
If information is provided in the future, a supplemental report will be issued.
 
Event Description
According to the reporter, when the device was being introduced to the patient, resistance was evident.The first third of the pull apart was observed to be wrinkled and a crack was observed in the luer adapter.The catheter was not repaired and there was no leak.No instrument was used to loosen or tighten the device they had to open a new catheter kit.There were no other deficient products used during the event.There were no patient symptoms, complications, or adverse reaction associated with this event and no medicalor surgical intervention needed to prevent a permanent impairment of a function.The event did not lead to or extend patient hospitalization.There was no patient injury.
 
Manufacturer Narrative
Additional information: a1, a3, a5, a5b, b5, g4.Medtronic is submitting this report to comply with fda reporting regulations under 21 cfr parts 4 and 803.This report is based upon information obtained by medtronic, which the company may not have been able to fully investigate or verify prior to the date the report was required by the fda.Medtronic has made reasonable efforts to obtain more complete information and has provided as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.In particular, this report does not constitute an admission by anyone that the product described in this report has any ¿defects¿ or has ¿malfunctioned¿.These words are included in the fda 3500a form and are fixed items for selection created by the fda to categorize the type of event solely for the purpose of regulatory reporting.Medtronic objects to the use of these words and others like them because of the lack of definition and the connotations implied by these terms.This statement should be included with any information or report disclosed to the public under the freedom of information act.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.A good faith effort will be made to obtain the applicable information relevant to the report.If information is provided in the future, a supplemental report will be issued.
 
Event Description
According to the reporter, when the pull apart sheath was being introduced to the patient, resistance was evident and had a crack.The first third of the pull apart was observed to be wrinkled and a crack was observed in the luer adapter.The catheter was not repaired and there was no leak.No instrument was used to loosen or tighten the device and no cleaning agents were used on the device.There was nothing unusual observed on the device prior to use and flushing was not done.There was no occlusion and there was no other intervention/treatment required as a result of the event.They had to open a new catheter kit and the procedure was completed.There were no other deficient products used during the event.There were no patient symptoms, complications, or adverse reaction associated with this event and no medical or surgical intervention needed to prevent a permanent impairment of a function.The event did not lead to or extend patient hospitalization.There was no patient injury.
 
Manufacturer Narrative
This event has been reassessed and found to be a non-mdr reportable complaint.Medtronic is submitting this report to comply with fda reporting regulations under 21 cfr parts 4 and 803.This report is based upon information obtained by medtronic, which the company may not have been able to fully investigate or verify prior to the date the report was required by the fda.Medtronic has made reasonable efforts to obtain more complete information and has provided as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.In particular, this report does not constitute an admission by anyone that the product described in this report has any ¿defects¿ or has ¿malfunctioned¿.These words are included in the fda 3500a form and are fixed items for selection created by the fda to categorize the type of event solely for the purpose of regulatory reporting.Medtronic objects to the use of these words and others like them because of the lack of definition and the connotations implied by these terms.This statement should be included with any information or report disclosed to the public under the freedom of information act.
 
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Brand Name
PALINDROME
Type of Device
CATHETER, HEMODIALYSIS, IMPLANTED
Manufacturer (Section D)
COVIDIEN MFG SOLUTIONS S.A.
edificio b20, calle #2
alajuela 20101
MDR Report Key10125264
MDR Text Key194338546
Report Number3009211636-2020-00107
Device Sequence Number1
Product Code MSD
UDI-Device Identifier10884521013148
UDI-Public10884521013148
Combination Product (y/n)N
PMA/PMN Number
K111372
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative,foreig
Type of Report Initial,Followup,Followup
Report Date 07/14/2020
1 Device was Involved in the Event
1 Patient was Involved in the Event
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator Health Professional
Device Model Number8888145014
Device Catalogue Number8888145014
Device Lot Number1919800096
Was Device Available for Evaluation? No
Initial Date Manufacturer Received 05/20/2020
Initial Date FDA Received06/05/2020
Supplement Dates Manufacturer Received06/12/2020
06/25/2020
Supplement Dates FDA Received06/29/2020
07/14/2020
Is This a Reprocessed and Reused Single-Use Device? No
Patient Sequence Number1
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