MAUDE Adverse Event Report: COLOPLAST A/S HYDRO X-FLOW CATHETER SILICONE WITH HYDROGEL COATING; INDWELLING URETHRAL DRAINAGE BALLOON CATHETER, NON-ANTIMICROBIAL

Catalog Number XB6322

Device Problem Complete Blockage (1094)

Patient Problem Fluid Discharge (2686)

Event Date 12/01/2023

Event Type  malfunction  

Event Description

According to the available information the catheter appeared to be clogged.The urine flowed into the meatus and not into the tube.There was leakage of urine and ineffectiveness of the catheter.The catheter was changed successfully.

• Brand Name: HYDRO X-FLOW CATHETER SILICONE WITH HYDROGEL COATING
• Type of Device: INDWELLING URETHRAL DRAINAGE BALLOON CATHETER, NON-ANTIMICROBIAL
• Manufacturer (Section D): COLOPLAST A/S; 1 holtedam humlebaek, dk 3050; humlebaek 3050 ; DA 3050
• Manufacturer (Section G): CMF-SARLAT; 9 avenue edmond rostand; sarlat-la-caneda ; FR
• Manufacturer Contact: usbes brian schmidt ; 1601 west river road n; minneapolis, MN 55411
• MDR Report Key: 18446149
• MDR Text Key: 331935406
• Report Number: 9610711-2024-00007
• Device Sequence Number: 1
• Product Code: EZL
• UDI-Device Identifier: 03600040260890
• UDI-Public: 3600040260890
• Combination Product (y/n): N
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Foreign,Health Professional
• Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date: 01/04/2024

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 Operator: Health Professional
• Device Catalogue Number: XB6322
• Device Lot Number: 9143129_XB63221002
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: Not provided
• Initial Date FDA Received: 01/04/2024
• Date Device Manufactured: 04/28/2023
• 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