MAUDE Adverse Event Report: TELEFLEX HUDSON NEBULIZER ADAPTOR 033, STERILE, JAPANESE

Catalog Number 031-33J

Device Problems Tear, Rip or Hole in Device Packaging (2385); Packaging Problem (3007)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 09/17/2014

Event Type  malfunction  

Event Description

The event is reported as: the distributor (b)(4) alleges that a pin hole was observed on the package during incoming inspection.A total of (15) packages were observed with this reported issue.

Manufacturer Narrative

No visual or functional inspection can be performed since the device sample is not available for evaluation.The device history record (dhr) for lot#02b1400691 was reviewed was found that an ncmr was opened for damage during transit.Complete lot was inspected 100% visual inspection.The product was re-inspected and re-packed, however this type of defect is easy to detect during the manufacturing of the product since is verified at 100%.Additionally, per internal procedure, distribution center performs 100% inspection as well.Dhr shows that the product was packed and inspected according to our specifications.During investigation it was found that component tfx-000354 (sheet foam) batch (b)(4) was used during the manufacturing process, this sheet foam was implemented to prevent product damage.No conclusion can be established at this time based on the lack of device sample.It is necessary to evaluate the physical sample in order to perform a proper investigation.If the product sample becomes available this complaint will be re-opened.However, manufacturing and r&d departments are evaluating the current packaging design, a proposal of a new packaging method has been identified, and therefore a process/design has been initiated.Personnel involved in the manufacturing process have been notified on this issue.

• Brand Name: HUDSON NEBULIZER ADAPTOR 033, STERILE, JAPANESE
• Type of Device: NEBULIZER ADAPTOR
• Manufacturer (Section D): TELEFLEX; rtp NC 27709
• Manufacturer Contact: margie burton, rn ; po box 12600; durham, NC 27709 ; 9194334965
• MDR Report Key: 4172813
• MDR Text Key: 5157706
• Report Number: 3004365956-2014-00368
• Device Sequence Number: 1
• Product Code: CCQ
• Combination Product (y/n): N
• Reporter Country Code: JA
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Distributor
• Reporter Occupation: Not Applicable
• Type of Report: Initial
• Report Date: 09/25/2014

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 10/10/2014
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Other
• Device Catalogue Number: 031-33J
• Device Lot Number: 02B1400691
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 09/25/2014
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 02/01/2014
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1