MAUDE Adverse Event Report: DAVOL INC., SUB. C.R. BARD, INC. -1213643 ENDO-FLO IRRIGATOR; LAPAROSCOPE, GENERAL & PLASTIC SURGERY

Catalog Number 0037970

Device Problem Fluid/Blood Leak (1250)

Patient Problem No Patient Involvement (2645)

Event Date 10/16/2020

Event Type  malfunction  

Manufacturer Narrative

As reported, the endo-flo irrigator device is being returned for evaluation.However, at this time has not been received.Based on the information provided to date, no conclusion can be made.Additional information has been requested.Review of manufacturing records indicate product was manufactured to specification.To date, this is the only reported complaint for this manufacturing lot of 360 units released for distribution in march, 2018.If/when the sample is received and evaluated or additional information is provided, a supplemental mdr will be submitted.Sample not returned.

Event Description

As reported, on (b)(6) 2020, the endo-flo irrigator leaked saline from the device during priming.As reported, another device was used to complete the procedure.There were no pieces found detached from the device.There was no reported patient involvement.

Event Description

As reported, on (b)(6) 2020, the endo-flo irrigator leaked saline from the device during priming.As reported, another device was used to complete the procedure.There were no pieces found detached from the device.There was no reported patient involvement.

Manufacturer Narrative

As reported, the endo-flo irrigator device is being returned for evaluation.However, at this time has not been received.Based on the information provided to date, no conclusion can be made.Additional information has been requested.Review of manufacturing records indicate product was manufactured to specification.To date, this is the only reported complaint for this manufacturing lot of (b)(4) units released for distribution in march, 2018.Addendum: this is an addendum to the initial mdr submitted.This supplemental mdr is submitted to report the results of the device evaluation.The subject product was returned for evaluation.Functional evaluation of the sample found no fluid leak identified from the endo-flo tubing or pump housing or at the luer lock connection.The endo-flo was found to irrigate as intended with no fluid leaks identified.Evaluation of the sample could not reproduce the reported event.No manufacturing anomalies were found.Based on the sample evaluation and investigation performed, the reported event was unconfirmed.H3 other text : sample evaluated.

• Brand Name: ENDO-FLO IRRIGATOR
• Type of Device: LAPAROSCOPE, GENERAL & PLASTIC SURGERY
• Manufacturer (Section D): DAVOL INC., SUB. C.R. BARD, INC. -1213643; 100 crossings blvd.; warwick RI 02886
• MDR Report Key: 10822193
• MDR Text Key: 215941700
• Report Number: 1213643-2020-20040
• Device Sequence Number: 1
• Product Code: HET
• UDI-Device Identifier: 00801741065217
• UDI-Public: (01)00801741065217
• Combination Product (y/n): N
• PMA/PMN Number: K902722
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,distri
• Type of Report: Initial,Followup
• Report Date: 11/13/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 11/11/2020
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 02/28/2021
• Device Catalogue Number: 0037970
• Device Lot Number: JUCQF282
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 11/12/2020
• Date Manufacturer Received: 11/12/2020
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Other