MAUDE Adverse Event Report: B.BRAUN SURGICAL SA HISTOACRYL BLUE 0.5ML; TISSUE ADHESIVES

Model Number 1050044

Device Problem Partial Blockage (1065)

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

Event Type  malfunction  

Manufacturer Narrative

Reported device not marketed in the u.S., however, similar devices or devices that share components, raw materials, process methods or any other technological characteristics with a medical device that is registered within the u.S.(b)(4).B braun subsidiary received information on 07/13/2016, manufacturer was notified of complaint on 08/11/2016.Manufacturing site evaluation: evaluation is on-going.

Event Description

Country of complaint: (b)(6).The surgeon reported that during surgery they had to cut off the tip to the tube instead of twisting off the tip.There was a adhesive clot that blocked the end of the tube.

Manufacturer Narrative

Samples received: 3 unopened pouches.Analysis and results: there are 4 other complaints of this code batch received, but from other customers.(b)(4) units were manufactured and distributed in the market.There are no units in stock.In the ampoules received, there are polymerization nuclei along the cannula that caused the obstruction of the cannula.Ageing studies were performed with the purpose of provoking the complained defect and study the influence of environmental conditions in its apparition.Ageing studies were performed with the purpose of provoking the complained defect and study the influence of environmental conditions in its apparition.-ampoules were stressed for 9 days at 40ºc and 30 % rh.After 4 days of exposure, the stress conditions caused the apparition of some polymerization nuclei along the cannula in the ampoules.However, the liquid glue could still pass through the cannula, that was not obstructed.After 9 days of exposure, the polymerization nuclei observed caused the obstruction of the cannula.The environmental conditions influence the apparition of the polymerization nuclei along the cannula.A temperature of 40ºc caused the formation of polymerization nuclei along the cannula and the obstruction of the cannula after 9 days of exposure.The instructions for use, histoacryl should be stored at ambient temperature below 22ºc.The ampoule containing the adhesive should only be removed from the aluminum pouch immediately prior to application.Final conclusion: taking into account that the samples received do not fulfill the oem specifications, it is concluded that the complaint is justified.Corrective/preventive actions: according to our internal procedures, there is no need to establish corrective or preventive actions.Nevertheless, this complaint is recorded for trending analysis to assess if actions are needed in the future.

• Brand Name: HISTOACRYL BLUE 0.5ML
• Type of Device: TISSUE ADHESIVES
• Manufacturer (Section D): B.BRAUN SURGICAL SA; 121 carretera de terrassa; rubi, barcelona 08191 ; SP 08191
• Manufacturer (Section G): B.BRAUN SURGICAL SA; 121 carretera de terrassa; rubi, barcelona 08191 ; SP 08191
• Manufacturer Contact: nicole broyles ; 615 lambert pointe drive; hazelwood, MO 63042 ; 3145515988
• MDR Report Key: 5979833
• MDR Text Key: 55718209
• Report Number: 2916714-2016-00741
• Device Sequence Number: 1
• Product Code: MPN
• Combination Product (y/n): N
• Reporter Country Code: CH
• PMA/PMN Number: NARRATIVE
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,foreig
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 12/05/2016

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 09/27/2016
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 05/01/2017
• Device Model Number: 1050044
• Device Catalogue Number: 1050044
• Device Lot Number: 215223N2
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 09/07/2016
• Is the Reporter a Health Professional?: No
• Distributor Facility Aware Date: 08/18/2016
• Date Manufacturer Received: 10/21/2016
• Was Device Evaluated by Manufacturer?: Yes
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Other