MAUDE Adverse Event Report: ARROW INTERNATIONAL INC. EPIDURAL NEEDLE KIT; ANESTHESIA CONDUCTION KIT

Catalog Number LG-03000

Device Problem Break (1069)

Patient Problem Not Applicable (3189)

Event Date 05/05/2016

Event Type  malfunction  

Manufacturer Narrative

(b)(4).The device has been returned but the investigation report has not been submitted at this time.The manufacturer will continue to monitor and trend related events.

Event Description

Reported event: when the kit was opened the lidocaine vial was found broken.

Manufacturer Narrative

(b)(4).A device history record review was performed on the kit and the lidocaine ampule with no relevant findings.The customer returned one opened kit for investigation ((b)(4)).The contents of the kit were visually examined with and without magnification.Visual examination of the kit revealed that the lidocaine ampule is broken at the score line.The body of the ampule was received taped in its compartment and the cap was found taped in the compartment where the prep tray goes.No other contents were present in the received kit.No pieces of the ampule appear to be missing.No other defects or anomalies were observed ((b)(4)).A corrective action is not required at this time as it cannot be determined at what point the lidocaine ampule broke.However, shipping and handling could not be eliminated as potential causes.The reported complaint of a broken other remarks: lidocaine ampule was found to have broken at the score line.The body of the ampule was found taped in its compartment.No pieces of the ampule were missing.A device history record review was performed on the kit and the lidocaine ampule with no evidence to suggest a manufacturing related cause.Therefore, the potential cause of a broken ampule could not be determined.However, shipping and handling could not be eliminated as potential causes.

Event Description

Reported event: when the kit was opened the lidocaine vial was found broken.

• Brand Name: EPIDURAL NEEDLE KIT
• Type of Device: ANESTHESIA CONDUCTION KIT
• Manufacturer (Section D): ARROW INTERNATIONAL INC.; reading PA
• Manufacturer (Section G): ARROW INTERNATIONAL INC.; 312 commerce place; asheboro NC 27203
• Manufacturer Contact: jasmine brown ; 3015 carrington mill blvd; morrisville, NC 27560 ; 9193614124
• MDR Report Key: 5678508
• MDR Text Key: 45877632
• Report Number: 1036844-2016-00257
• Device Sequence Number: 1
• Product Code: CAZ
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,health
• Reporter Occupation: Nurse
• Type of Report: Initial,Followup
• Report Date: 05/05/2016

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 05/25/2016
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 11/30/2017
• Device Catalogue Number: LG-03000
• Device Lot Number: 23F15M0584
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 05/16/2016
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 06/20/2016
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 12/15/2015
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: N
• Patient Sequence Number: 1