MAUDE Adverse Event Report: MEDLINE INDUSTRIES INC. MEDLINE; CATHETER,FOLEY,100%SILICONE,16FR,10ML,LF

Model Number DYND11502

Device Problems Material Rupture (1546); Device Fell (4014)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 03/17/2021

Event Type  malfunction  

Manufacturer Narrative

It was reported that a patient was undergoing an unspecified surgical procedure and prior to the procedure being performed the surgeon placed a catheter while the patient was in the operating room.Reportedly, after the procedure was completed, the patient was resting in bed calm and inactive when the catheter came out of place.The patient reported that he did not pull on/out the catheter.The night shift nurse who found the dislodged catheter in the bed assessed the patient and the catheter and noted that the balloon of the catheter was completely deflated.There was no reported trauma or injury to the patient.The nurse called the urologist and a new catheter was reinserted.The actual sample was disposed of and is not available to be returned for evaluation.There is no additional information available.Due to the reported incident and in an abundance of caution, this medwatch is being filed.If additional relevant information becomes available a supplemental medwatch will be filed.

Event Description

It was reported that the balloon of the catheter became fully deflated and the catheter fell out of the patient after being shortly after being secured requiring a new catheter to be placed.

• Brand Name: MEDLINE
• Type of Device: CATHETER,FOLEY,100%SILICONE,16FR,10ML,LF
• Manufacturer (Section D): MEDLINE INDUSTRIES INC.; three lakes drive; northfield IL 60093
• Manufacturer Contact: karen trutsch ; three lakes drive; northfield, IL 60093
• MDR Report Key: 12023865
• MDR Text Key: 260236535
• Report Number: 1417592-2021-00105
• Device Sequence Number: 1
• Product Code: EZL
• UDI-Device Identifier: 10884389034538
• UDI-Public: 10884389034538
• 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
• Reporter Occupation: Nurse
• Type of Report: Initial
• Report Date: 06/18/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: DYND11502
• Device Catalogue Number: DYND11502
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 06/08/2021
• Initial Date FDA Received: 06/18/2021
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unknown
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Age: 71 YR
• Patient Weight: 93