MAUDE Adverse Event Report: ANGIODYNAMICS DURAFLOW 2 CHRONIC HEMODIALYSIS CATHETER

Catalog Number H787103012031

Device Problem Detachment Of Device Component (1104)

Patient Problem Device Embedded In Tissue or Plaque (3165)

Event Date 02/17/2017

Event Type  Injury  

Manufacturer Narrative

It was reported that the disposable device was discarded by the user and is not available to be returned to the manufacturer for evaluation.An investigation into the root cause of this incident is currently in progress.The results of the device evaluation will be sent via a follow up medwatch.(b)(4).

Event Description

Per user medwatch mw5068034, received on march 10, 2017: patient had a tunneled ij hemodialysis catheter on (b)(6) 2013.The patient was scheduled to have it removed.Upon removal of the catheter, it was noted that the cuff was retained inside the patient.An expert physician was contacted for assistance.She was unable to locate the cuff and it was decided that attempting to locate/remove it would cause more damage than leaving it in.The patient was later discharged with information and instructions related to the retained cuff.The event did not result in prolonged hospitalization or injury to the patient.It was reported the defective disposable device is not available for return to the manufacturer as it was disposed of by the user.

• Brand Name: DURAFLOW 2 CHRONIC HEMODIALYSIS CATHETER
• Type of Device: HEMODIALYSIS CATHETER
• Manufacturer (Section D): ANGIODYNAMICS; 603 queensbury avenue; queensbury NY 12804
• Manufacturer (Section G): ANGIODYNAMICS; 603 queensbury avenue; queensbury NY 12804
• Manufacturer Contact: lawrence ryan ; 603 queensbury avenue; queensbury, NY 12804 ; 5187424488
• MDR Report Key: 6463256
• MDR Text Key: 71838478
• Report Number: 1319211-2016-00037
• Device Sequence Number: 1
• Product Code: MSD
• UDI-Device Identifier: H787103012031
• UDI-Public: H787103012031
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K110936
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: health professional,user faci
• Reporter Occupation: Risk Manager
• Type of Report: Initial
• Report Date: 04/05/2017

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?: Yes
• Device Operator: No Information
• Device Expiration Date: 08/01/2014
• Device Catalogue Number: H787103012031
• Device Lot Number: 566484
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Initial Date Manufacturer Received: 03/10/2017
• Initial Date FDA Received: 04/06/2017
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 01/20/2014
• 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
• Patient Outcome(s): Required Intervention