MAUDE Adverse Event Report: CARDINAL HEALTH CONT. FEEDING SET; TUBES, GASTROINTESTINAL (AND ACCESSORIES)

Model Number 8884741821

Device Problem Detachment of Device or Device Component (2907)

Patient Problem Insufficient Information (4580)

Event Type  malfunction  

Manufacturer Narrative

An investigation is currently underway.Upon completion, the results will be forwarded.

Event Description

The nurse reported that the item is broken where it connects to the pump.

Manufacturer Narrative

The device history record (dhr) could not be reviewed since no lot number was provided from customer complaint report.A sample analysis was not possible as there was no photographs or samples provided for evaluation.Without a sample we are unable to perform a thorough follow up investigation to include functional and visual evaluation to determine the root cause(s) of the reported condition or implement any corrective action(s).If a sample should be returned, this complaint will be reopened, and the investigation updated to reflect our findings.Since this complaint will be considered unconfirmed, no corrective or preventive actions will be taken at this time.

• Brand Name: CONT. FEEDING SET
• Type of Device: TUBES, GASTROINTESTINAL (AND ACCESSORIES)
• Manufacturer (Section D): CARDINAL HEALTH; 777 west street; mansfield MA 02048
• Manufacturer (Section G): CARDINAL HEALTH; calle 9 sur no. 125 cuidad ind; tijuana 22500 ; MX 22500
• Manufacturer Contact: jill saraiva ; 777 west street; mansfield, MA 02048 ; 5086183640
• MDR Report Key: 16195588
• MDR Text Key: 307896704
• Report Number: 9612030-2023-03526
• Device Sequence Number: 1
• Product Code: KNT
• UDI-Device Identifier: 30884521011650
• UDI-Public: 30884521011650
• Combination Product (y/n): N
• Reporter Country Code: CA
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,User Facility,Company Representative
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 02/16/2023

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 Model Number: 8884741821
• Device Catalogue Number: 8884741821
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Initial Date Manufacturer Received: 12/30/2022
• Initial Date FDA Received: 01/18/2023
• Supplement Dates Manufacturer Received: 12/30/2022
• Supplement Dates FDA Received: 02/16/2023
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Type of Device Usage: A
• Patient Sequence Number: 1