MAUDE Adverse Event Report: MEDLINE INDUSTRIES LP; MINOR PLASTICS PACK

Catalog Number DYNJ82196

Device Problem Material Integrity Problem (2978)

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

Event Date 08/14/2023

Event Type  malfunction  

Manufacturer Narrative

It was reported by the customer that on (b)(6) 2023, "tail of the lap sponge was found in the basin".It was reported that all lap sponges were accounted for.Due to the reported incident, an additional 45 minutes of procedure time was required and additional xrays were required.A sample was requested to be returned for evaluation.It has been determined that the reported event could cause or contribute to serious injury if it were to occur.In an abundance of caution, this medwatch is being filed.If any further relevant information is identified or obtained, a supplemental medwatch will be submitted.

Event Description

Tail of lap sponge found which resulted in additional procedure time and xrays.

• Type of Device: MINOR PLASTICS PACK
• Manufacturer (Section D): MEDLINE INDUSTRIES LP; three lakes drive; northfield IL 60093
• Manufacturer Contact: kelly zampella ; three lakes drive; northfield, IL 60093
• MDR Report Key: 17700299
• MDR Text Key: 322860098
• Report Number: 1423395-2023-00052
• Device Sequence Number: 1
• Product Code: FTN
• UDI-Device Identifier: 10195327183509
• UDI-Public: 10195327183509
• 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: Other
• Type of Report: Initial
• Report Date: 09/07/2023

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 Catalogue Number: DYNJ82196
• Device Lot Number: 23GDB788
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 08/22/2023
• Initial Date Manufacturer Received: 08/14/2023
• Initial Date FDA Received: 09/07/2023
• Was Device Evaluated by Manufacturer?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unknown
• Patient Sequence Number: 1
• Patient Outcome(s): Other