MAUDE Adverse Event Report: TELEFLEX MEDICAL DERMAHOOK 1/2 HOOK 10 PKG/BX 6 HKS/PKG

Catalog Number 382805

Device Problem Degraded (1153)

Patient Problem No Information (3190)

Event Date 08/27/2015

Event Type  malfunction  

Manufacturer Narrative

(b)(4).The device history review for the product dermahook 1/2 hook 10 pkg/bx 6 hks/pkg, lot number 73e1500060 investigation did not show issues related to the complaint.The device sample has not been returned for investigation at the time of this report.The manufacturer will continue to monitor and trend related events.

Event Description

Alleged event: rubber bands are popping and appear to be dry rotted.There is no reported patient involvement.

• Brand Name: DERMAHOOK 1/2 HOOK 10 PKG/BX 6 HKS/PKG
• Manufacturer (Section D): TELEFLEX MEDICAL; research triangle park NC
• Manufacturer (Section G): TELEFLEX MEDICAL; rancho el descanso; tecate 21478 ; MX 21478
• Manufacturer Contact: effie jefferson ; 3015 carrington mill blvd; morrisville, NC 27560 ; 9194332672
• MDR Report Key: 5061805
• MDR Text Key: 25846238
• Report Number: 3003898360-2015-00640
• Device Sequence Number: 1
• Product Code: GDG
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,health
• Reporter Occupation: Nurse
• Type of Report: Initial
• Report Date: 09/03/2015

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 09/08/2015
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 11/12/2016
• Device Catalogue Number: 382805
• Device Lot Number: 73E1500060
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 09/03/2015
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 05/06/2015
• Is the Device Single Use?: Yes
• Type of Device Usage: N
• Patient Sequence Number: 1