MAUDE Adverse Event Report: MERIT MEDICAL SYSTEMS, INC. PRESSURE INFUSION; INFUSOR, PRESSURE, FOR I.V. BAGS

Catalog Number PIB500

Device Problems Air Leak (1008); Loss of or Failure to Bond (1068)

Patient Problem No Known Impact Or Consequence To Patient (2692)

Event Date 05/27/2014

Event Type  malfunction  

Event Description

The user reported that the pressure infusion bag is losing pressure.The leak was discovered before the procedure began.No harm or injury to the patient was reported.

Manufacturer Narrative

Device evaluation: one used suspect device was returned for evaluation.The device history record was reviewed and no exception documents were found.The complaint database was reviewed and several similar complaints for this lot number were found.The bag was pressure tested and failed the pressure test.The failure was attributed to the bond between the tubing and the bag.The complaint is confirmed.A supplier corrective action has been requested from the manufacturer.

• Brand Name: PRESSURE INFUSION
• Type of Device: INFUSOR, PRESSURE, FOR I.V. BAGS
• Manufacturer (Section D): MERIT MEDICAL SYSTEMS, INC.; south jordan UT
• Manufacturer Contact: jerry mcphie ; 1600 west merit pkwy.; south jordan, UT 84095 ; 8012084491
• MDR Report Key: 3966466
• MDR Text Key: 16082267
• Report Number: 1721504-2014-00128
• Device Sequence Number: 1
• Product Code: KZD
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: EXEMPT
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional,User Facility,Company Representative
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date: 05/27/2014

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 06/25/2014
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 03/31/2017
• Device Catalogue Number: PIB500
• Device Lot Number: I668545
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 06/06/2014
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 05/27/2014
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 07/01/2013
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unknown
• Patient Sequence Number: 1