MAUDE Adverse Event Report: COOK INC ULTRATHANE MULTIPURPOSE DRAINAGE CATHETER; GBO CATHETER, NEPHROSTOMY, GENERAL & PLASTIC SURGERY

Model Number N/A

Device Problem Migration or Expulsion of Device (1395)

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

Event Date 04/02/2021

Event Type  Injury  

Event Description

It was reported that the patient underwent a study procedure ((b)(6)) to place a cook ultrathane mac-loc locking loop multipurpose drainage catheter on (b)(6) 2021 for "other drainage" and the device was being used as a nephroureteral stent.Dilation was performed prior to catheter insertion, then the catheter was placed using ultrasound and fluoroscopy for visual guidance.On (b)(6) 2021 it was discovered that the drainage catheter had retracted outside the kidney.Complete fluid evacuation was not able to be achieved using this device.The device was removed and replaced on (b)(6) 2021.No adverse events were reported prior to the patient's exit from the study.

Manufacturer Narrative

Pma/510(k) #: exempt.This report includes information known at this time.A follow-up report will be submitted should additional relevant information become available.

Manufacturer Narrative

Blank fields on this form indicate the information is unknown, unavailable, or unchanged.Investigation ¿ evaluation.It was reported by baylor university medical center that a patient underwent a study procedure (mdr-1919) to place a cook ultrathane mac-loc locking loop multipurpose drainage catheter (rpn: ult8.5-38-35-p-clms-16-rh-fs; lot#: 13433113) for use as a nephroureteral stent.Dilation was performed prior to catheter insertion, then the catheter was placed using ultrasound and fluoroscopy for visual guidance.Two days after placement, it was discovered that the drainage catheter had retracted outside the kidney.As a result, the device was removed and replaced.No additional adverse events were reported prior to the patient's exit from the study.Reviews of the complaint history, device history record (dhr), quality control procedures, manufacturing instructions (mi), and instructions for use (ifu) were conducted during the investigation.The complaint device was not returned to the manufacturer for evaluation; therefore, no physical examinations could be conducted.However, a document-based investigation evaluation was performed.A review of the device master record (dmr) concluded that sufficient inspection activities are in place to identify this failure mode prior to distribution.A review of the dhr for the reported complaint device lot 13433113 and related subassembly lots revealed no relevant non-conformances.A database search did not identify any other events associated with the reported device lot.Based on the available information, cook has concluded that the device was manufactured to specification and that there is no evidence suggesting nonconforming product exists either in house or in field.Cook also reviewed product labeling.The instructions for use (ifu) [ t_multi2_rev1, multipurpose drainage catheter] states the following.¿how supplied: upon removal from package, inspect the product to ensure no damage has occurred.Intended use: multiple drainage catheters are intended for percutaneous drainage applications (e.G nephrostomy, biliary and abscess), either by direct stick or seldinger access technique.Warnings: if a catheter has become malposition or if drainage ceases, the catheter should be promptly exchanged or removed.References: these instructions for use are based on experience from physicians and (or) their published literature.Refer to your local cook sales representative for information on available literature.¿ based on the available information, no product returned, and the results of the investigation, a root cause was unable to be established.The appropriate personnel have been notified.Cook will continue to monitor for similar complaints.Per the risk assessment no further action is required.This report is required by the fda under 21 cfr part 803 and is based on unconfirmed information submitted by others.Neither the submission of this report nor any statement contained herein is intended to be an admission that any cook device is defective or malfunctioned, that a death or serious injury occurred, nor that any cook device caused, contributed to, or is likely to cause or contribute to a death or serious injury if a malfunction occurred.

Event Description

No additional information regarding the patient and/or event has been received since the previous medwatch report was sent.

• Brand Name: ULTRATHANE MULTIPURPOSE DRAINAGE CATHETER
• Type of Device: GBO CATHETER, NEPHROSTOMY, GENERAL & PLASTIC SURGERY
• Manufacturer (Section D): COOK INC; 750 daniels way; bloomington IN 47404
• Manufacturer (Section G): COOK INC.; 750 daniels way; bloomington IN 47404
• Manufacturer Contact: jason crouch ; 750 daniels way; bloomington, IN 47404 ; 8123392235
• MDR Report Key: 14959439
• MDR Text Key: 295598930
• Report Number: 1820334-2022-01175
• Device Sequence Number: 1
• Product Code: GBO
• UDI-Device Identifier: 00827002270480
• UDI-Public: (01)00827002270480(17)230916(10)13433113
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Other,Study,Company Representative
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 12/19/2022

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 Expiration Date: 09/16/2023
• Device Model Number: N/A
• Device Catalogue Number: ULT8.5-38-35-P-CLMS-16-RH-FS
• Device Lot Number: 13433113
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Initial Date Manufacturer Received: 06/22/2022
• Initial Date FDA Received: 07/08/2022
• Supplement Dates Manufacturer Received: 11/29/2022
• Supplement Dates FDA Received: 12/19/2022
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 09/16/2020
• 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): Required Intervention
• Patient Age: 60 YR
• Patient Sex: Male
• Patient Weight: 86 KG