MAUDE Adverse Event Report: CONVATEC INC. ABVISER AUTOVALVE IAP MONITORING DEVICE, POLE MOUNT; DEVICE, CYSTOMETRIC, HYDRAULIC

Model Number ABV301

Device Problem Leak/Splash (1354)

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

Event Type  malfunction  

Manufacturer Narrative

Initial emdr is being re-submitted per request of fda on 29-apr-2021.Reported to the fda on 06-nov-2015 on 17-dec-2015, the following correction was identified: the report submitted on 06-nov-2015, with the patient identifier (b)(6), had the incorrect manufacturer report number listed 1722554-2015-31299.The correct manufacturers report number should have been 1049092-2015-31299.In addition, fields has been updated to reflect this correction.Please note, field has also been updated.Reported to the fda on 18-dec-2015.Fda registration number: reporting site: (b)(4).Manufacturing site: (b)(4).

Event Description

It was reported that the connection between auto valve and drain bag was leaking.

• Brand Name: ABVISER AUTOVALVE IAP MONITORING DEVICE, POLE MOUNT
• Type of Device: DEVICE, CYSTOMETRIC, HYDRAULIC
• Manufacturer (Section D): CONVATEC INC.; 211 american ave.; greensboro NC 27409
• Manufacturer Contact: pamela meadows ; 7815 national service road; suite 600; greensboro, NC 27409 ; 3365424679
• MDR Report Key: 5309717
• MDR Text Key: 266968323
• Report Number: 1049092-2015-31299
• Device Sequence Number: 1
• Product Code: FEN
• Combination Product (y/n): N
• Reporter Country Code: TW
• PMA/PMN Number: EXEMPT
• 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: 02/27/2014

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: ABV301
• Device Lot Number: 11003D
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: 02/27/2014
• Initial Date FDA Received: 12/18/2015
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Unknown
• Patient Sequence Number: 1