MAUDE Adverse Event Report: MEX03 MEXICO-JUAREZ PRESOURCE IR NEURO PACK 629; NEUROLOGICAL TRAY

Model Number SAN44IRUTA

Device Problem Material Fragmentation (1261)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 04/29/2020

Event Type  malfunction  

Manufacturer Narrative

From the device history record, lot# 20190920-23-sh was manufactured on 26th sep 2019.No exception was recorded in the device history record that could lead to the reported incident.The average linting data is 0.184g / 10 pieces.A sample was not available at the time of the investigation, only photo of blue lint was provided.According to supplier, or towel is made of cotton, so cotton fiber is born.Supplier is continuously working with cardinal health to better control the linting and have implemented several measures to improve it: suctions machines have been installed in grey cloth rolling process, dyeing process and cutting process the suction process was added before product's final folding, and workers do it according to standard operation procedure requirement.Linting test method and acceptable criteria was stipulated to see the suction results.(=0.38g/10 pieces).In the folding process, supplier used one cloth pad under 100 pieces semi-finished products to avoid linting stuck onto the products during product's transfer.From the investigation, no abnormal situation happened in production.Therefore, the root cause could not be determined.The complaint information was informed to the relevant sectors for their awareness.There is no action taken at this time, but supplier will continue to monitor the trend of this type of incident.

Event Description

Customer reported that the blue, sterile, cotton or towels pwtb04-stm, from the ir neuro pack san44iruta are shedding fibers onto various wires and catheters during a intracranial embolization.The towels were used for fluid absorption outside the drape.There was no injury or delay.Cardinal health is filing a report for malfunction.

• Brand Name: IR NEURO PACK 629
• Type of Device: NEUROLOGICAL TRAY
• Manufacturer (Section D): MEX03 MEXICO-JUAREZ PRESOURCE; c. arcadia 1580 , col. terraza; cd.juarez , chihuahua CP 32 599; MX CP 32599
• Manufacturer (Section G): MEX03 MEXICO-JUAREZ PRESOURCE; c. arcadia 1580 , col. terraza; cd.juarez , chihuahua CP 32 599; MX CP 32599
• Manufacturer Contact: patricia tucker ; 3651 birchwood drive; waukegan, IL 60085 ; 8478874151
• MDR Report Key: 10063105
• MDR Text Key: 208344848
• Report Number: 1423537-2020-00460
• Device Sequence Number: 1
• Product Code: OJG
• UDI-Device Identifier: 10888439390407
• UDI-Public: 10888439390407
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: health professional,user faci
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 05/15/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: No Information
• Device Model Number: SAN44IRUTA
• Device Catalogue Number: SAN44IRUTA
• Device Lot Number: 339307
• Was Device Available for Evaluation?: Yes
• Initial Date Manufacturer Received: 04/30/2020
• Initial Date FDA Received: 05/15/2020
• Date Device Manufactured: 10/30/2019
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Other