MAUDE Adverse Event Report: MEDLINE INDUSTRIES LP 14FR COUDE URINEMETER TRAY; Catheter care tray

Catalog Number URO170814C

Device Problem Deflation Problem (1149)

Patient Problem Insufficient Information (4580)

Event Date 10/17/2023

Event Type  malfunction  

Manufacturer Narrative

It was reported by the customer contact that on 10/17/23, the balloon of a coude catheter was found deflated and the catheter had come out of the patient.No additional details were provided related to the incident.A sample was requested to be returned for evaluation.It has been determined that the reported event could cause or contribute to serious injury if it were to occur.In an abundance of caution, this medwatch is being filed.If any further relevant information is identified or obtained, a supplemental medwatch will be submitted.

Event Description

Balloon deflated causing catheter to come out.

• Brand Name: 14FR COUDE URINEMETER TRAY
• Type of Device: Catheter care tray
• Manufacturer (Section D): MEDLINE INDUSTRIES LP; three lakes drive; northfield IL 60093
• Manufacturer Contact: kelly zampella ; three lakes drive; northfield, IL 60093
• MDR Report Key: 18140898
• MDR Text Key: 328372588
• Report Number: 1417592-2023-00449
• Device Sequence Number: 1
• Product Code: OHR
• UDI-Device Identifier: 10889942905799
• UDI-Public: 10889942905799
• 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
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 11/15/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 11/15/2023
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Catalogue Number: URO170814C
• Device Lot Number: 23DBD175
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 11/01/2023
• Date Manufacturer Received: 10/18/2023
• Was Device Evaluated by Manufacturer?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unknown
• Patient Sequence Number: 1
• Patient Outcome(s): Other