MAUDE Adverse Event Report: 3M HEALTH CARE 3M MICROPORE SURGICAL TAPE; TAPE AND BANDAGE, ADHESIVE

Model Number N/A

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problems Erythema (1840); Skin Inflammation/ Irritation (4545)

Event Date 06/09/2023

Event Type  Injury  

Manufacturer Narrative

H10: a sample has been returned and a lot number was provided; analysis is ongoing.End of report.

Event Description

Skin rash with redness and itchiness on the right breast five days post-op at the application site of 3m¿ micropore¿ surgical tape, 1530-1 to cover a surgical incision.The patient came into the office early due to the rash, described as textured and raised along the horizontal incision site and around 1-inch beyond the site.A medrol® dosepak¿ and temovate® (clobetasol propionate topical) were prescribed for what was described as minor symptoms.The office has not heard back from the patient since.The reporter informed that they have used this tape product for several years without issue.The reporter felt that the newer boxes of tape had a strong glue/chemical odor whereas older boxes with a black side did not.

Manufacturer Narrative

H10: a sample was returned for analysis and a lot number was provided.No issues were identified in the production history or with the sample returned.It is not possible to definitively determine the root cause.3m will continue to monitor.End of report.

• Brand Name: 3M MICROPORE SURGICAL TAPE
• Type of Device: TAPE AND BANDAGE, ADHESIVE
• Manufacturer (Section D): 3M HEALTH CARE; 2510 conway ave; st. paul MN 55144
• Manufacturer (Section G): 3M DEUTSCHLAND GMBH WERK KAMEN; edisonstrasse 6; 59174 kamen; kamen, deu, ; GM
• Manufacturer Contact: nadia battah ; 3m center, building 275-5w-06; 2510 conway ave; st. paul, MN 55144-1000 ; 6514612670
• MDR Report Key: 17411043
• MDR Text Key: 319929280
• Report Number: 2110898-2023-00069
• Device Sequence Number: 1
• Product Code: KGX
• UDI-Device Identifier: 04064035099688
• UDI-Public: 04064035099688
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: EXEMPT
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Health Professional
• Reporter Occupation: Nurse
• Type of Report: Initial,Followup
• Report Date: 08/02/2023

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?: No
• Device Operator: Health Professional
• Device Model Number: N/A
• Device Catalogue Number: 1530-1
• Device Lot Number: 105126291
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 07/18/2023
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 07/05/2023
• Initial Date FDA Received: 07/27/2023
• Supplement Dates Manufacturer Received: 07/05/2023
• Supplement Dates FDA Received: 08/02/2023
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 11/23/2022
• Is the Device Single Use?: No
• 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 Sex: Female