MAUDE Adverse Event Report: C.R. BARD, INC. (COVINGTON) -1018233 BARDEX I.C. FOLEY CATHETER; FOLEY CATHETER (LATEX)

Model Number 0165SI14

Device Problems Fluid/Blood Leak (1250); Decrease in Pressure (1490); Device Fell (4014)

Patient Problems No Consequences Or Impact To Patient (2199); Insufficient Information (4580)

Event Date 08/12/2020

Event Type  malfunction  

Manufacturer Narrative

The investigation is still in progress.Once the investigation is complete a supplemental report will be filed.

Event Description

It was reported that the catheter fell out of the patient.It seems to be a water leak.Per additional information via email from ibc on 31aug2020, it seemed that there were no visible damage.

Event Description

It was reported that the catheter fell out of the patient.It seems to be a water leak.Per additional information via email from ibc on 31aug2020, it seemed that there were no visible damage.

Manufacturer Narrative

The reported event was confirmed however the cause was unknown.Evaluation found tear at inflation funnel.Origin of tear could not be determined.Exact cause of sample condition could not be determined and possibly occurred post manufacturing.Potential root cause could be roughly handling during stripping process or exposed to sharp object.The device history record was reviewed and found nothing that could have caused or contributed to the reported event.The instructions for use were found adequate and state the following: "sterile: unless package has been opened or damage.Do not use ointments or lubricants having a petrolatum base.They will damage latex and may burst balloon.This product contains natural rubber latex which may cause allergic reactions." h11:section a through f - the information provided by bd represents all of the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bd.

• Brand Name: BARDEX I.C. FOLEY CATHETER
• Type of Device: FOLEY CATHETER (LATEX)
• Manufacturer (Section D): C.R. BARD, INC. (COVINGTON) -1018233; 8195 industrial blvd; covington GA 30014
• MDR Report Key: 10549033
• MDR Text Key: 211270820
• Report Number: 1018233-2020-06004
• Device Sequence Number: 1
• Product Code: MJC
• UDI-Device Identifier: 00801741016745
• UDI-Public: (01)00801741016745
• Combination Product (y/n): N
• PMA/PMN Number: K910318
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: distributor,other
• Type of Report: Initial,Followup
• Report Date: 01/14/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 09/17/2020
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 12/28/2023
• Device Model Number: 0165SI14
• Device Catalogue Number: 0165SI14
• Device Lot Number: 0AC116
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 09/11/2020
• Date Manufacturer Received: 12/24/2020
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1