MAUDE Adverse Event Report: ARROW INTERNATIONAL INC. EPIDURAL NEEDLE KIT17 GA. X 3-1/2"; ANESTHESIA CONDUCTION KIT

Catalog Number ASK-05500-KPR

Device Problem Break (1069)

Patient Problem Not Applicable (3189)

Event Date 06/30/2016

Event Type  malfunction  

Manufacturer Narrative

Qn#(b)(4).The investigation report for the returned device has not been submitted at this time.The manufacturer will continue to monitor and trend related events.

Event Description

When the kit was opened, the vial was broken.There were no reported injuries.

Manufacturer Narrative

(b)(4).A device history record review was performed on the kit and the saline ampule with no relevant findings.The customer reported an ampule was broken upon opening a kit.The customer returned one saline solution ampule broken into two pieces for investigation ((b)(4)).The ampule was visually examined with and without magnification.Visual examination of the ampule revealed the ampule is broken at the score line.No pieces of the ampule appear to be missing.No other defects or anomalies were observed ((b)(4)).A corrective action is not required at this time as it cannot be determined at what point the saline ampule broke.However, shipping and handling could not be eliminated as potential causes.The reported complaint of a broken ampule was confirmed based upon the sample received.The saline ampule was found to have broken at the score line.No pieces of the ampule were missing.A device history record review was performed on the kit and the saline ampule with no evidence to suggest a manufacturing related cause.Therefore, the potential cause of a broken ampule could not be determined.However, shipping and handling could not be eliminated as potential causes.

Event Description

When the kit was opened, the vial was broken.There were no reported injuries.

• Brand Name: EPIDURAL NEEDLE KIT17 GA. X 3-1/2"
• Type of Device: ANESTHESIA CONDUCTION KIT
• Manufacturer (Section D): ARROW INTERNATIONAL INC.; reading PA
• Manufacturer (Section G): ARROW INTERNATIONAL INC.; 312 commerce place; asheboro NC 27203
• Manufacturer Contact: jasmine brown ; 3015 carrington mill blvd; morrisville, NC 27560 ; 9193614124
• MDR Report Key: 5826078
• MDR Text Key: 50548329
• Report Number: 1036844-2016-00393
• Device Sequence Number: 1
• Product Code: CAZ
• 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: Physician
• Type of Report: Initial,Followup
• Report Date: 07/03/2016

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 07/27/2016
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 12/31/2017
• Device Catalogue Number: ASK-05500-KPR
• Device Lot Number: 23F15M0978
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 07/18/2016
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 08/18/2016
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 12/31/2015
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: N
• Patient Sequence Number: 1