MAUDE Adverse Event Report: MERIT MEDICAL SYSTEMS, INC. PRESSURE INFUSION PAG; 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 07/24/2014

Event Type  malfunction  

Event Description

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

Manufacturer Narrative

No device is expected to be returned for evaluation.The device history record was reviewed and no exception documents were found.The complaint device was reviewed and one similar complaint for this lot number was found.Because the unit was not returned, the root cause could not be determined.If the device is returned in the future, this investigation will be reopened and follow up submitted.A supplier corrective action has been requested from the manufacturer.

• Brand Name: PRESSURE INFUSION PAG
• 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: 4093205
• MDR Text Key: 4716125
• Report Number: 1721504-2014-00190
• 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: 07/24/2014

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 08/21/2014
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 06/30/2016
• Device Catalogue Number: PIB500
• Device Lot Number: I668544
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 07/24/2014
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 07/01/2014
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1