MAUDE Adverse Event Report: TELEFLEX MEDICAL PE ADULT-PED WET LF 6/CS; BOTTLE, COLLECTION, VACUUM

Model Number IPN028446

Device Problem Inability to Auto-Fill (1044)

Patient Problems Insufficient Information (4580); No Clinical Signs, Symptoms or Conditions (4582)

Event Date 05/12/2023

Event Type  malfunction  

Manufacturer Narrative

(b)(4).Complaint verification testing could not be performed as no sample was returned for analysis.A device history record review was performed and no relevant findings were identified.Without the device to evaluate the complaint could not be confirmed and the probable cause could not be determined from the available information.Teleflex will continue to monitor and trend for reports of this nature.Other remarks: n/a.Corrected data: n/a.

Event Description

It was reported that "the water seal chamber becomes overfilled with water after the pleura-vac has been set up.During set up in these instances, the water seal chamber has been set to the recommended 2 cm and the suction control chamber has been set to the recommended 20 cm of water.About an hour and a half after set up, it has been noticed that the water seal chamber is way over the 2 cm mark".At the time of this report, the customer has not returned our requests for additional information, specifically regarding patient details.If further information is received, the complaint file will be updated.

Event Description

It was reported that "the water seal chamber becomes overfilled with water after the pleura-vac has been set up.During set up in these instances, the water seal chamber has been set to the recommended 2 cm and the suction control chamber has been set to the recommended 20 cm of water.About an hour and a half after set up, it has been noticed that the water seal chamber is way over the 2 cm mark".

Manufacturer Narrative

(b)(4).Additional information received on 07 june 2023 states that the issue was resolved by using a new pler-evac from a different lot number.There was no patient harm or injury.Other remarks: n/a.Corrected data: n/a.

• Brand Name: PE ADULT-PED WET LF 6/CS
• Type of Device: BOTTLE, COLLECTION, VACUUM
• Manufacturer (Section D): TELEFLEX MEDICAL; morrisville NC
• Manufacturer (Section G): TELEFLEX MEDICAL; parque industrial finsa; nuevo laredo 88275 ; MX 88275
• Manufacturer Contact: katharine tarpley ; 3015 carrington mill blvd; morrisville, NC 27560
• MDR Report Key: 17070241
• MDR Text Key: 316598671
• Report Number: 3004365956-2023-00039
• Device Sequence Number: 1
• Product Code: KDQ
• UDI-Device Identifier: 34026704631279
• UDI-Public: 34026704631279
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional,User Facility,Company Representative
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 05/12/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Model Number: IPN028446
• Device Catalogue Number: A-7000-08LF
• Device Lot Number: 74E2201572
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Initial Date Manufacturer Received: 05/12/2023
• Initial Date FDA Received: 06/06/2023
• Supplement Dates Manufacturer Received: 05/24/2023
• Supplement Dates FDA Received: 06/30/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 05/16/2022
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Treatment: N/A.; N/A.