MAUDE Adverse Event Report: COOK INC THREE-WAY PLASTIC STOPCOCK; KGZ ACCESSORIES, CATHETER

Model Number N/A

Device Problems Break (1069); Leak/Splash (1354)

Patient Problem No Patient Involvement (2645)

Event Date 03/02/2017

Event Type  malfunction  

Manufacturer Narrative

(b)(4).This event is currently under investigation.

Event Description

An international customer reported that the stopcocks are breaking and / or leaking; it was stated "the neck has a tear." the event reportedly occurred prior to patient contact.No further information was provided.

Manufacturer Narrative

Corrected data: device available for evaluation.Device evaluated by manufacturer.Investigation - evaluation: a review of the complaint history, drawings, device history record, manufacturing instructions, trends, quality control and visual inspection of the returned device was conducted during the investigation.Five (5) three-way plastic stopcocks were returned in sealed package to assist with the investigation.All five were examined for non-conformities and tested for leaks.Two of the stopcocks passed, but three failed for cracks and/or leakage.A document based investigation evaluation was also performed.There is no evidence to suggest the product was not manufactured according to specifications.A review of the complaint history for this device was performed.It should be noted that there were no other reported complaints of this nature for this lot number.Measures have been conducted to address this failure mode.Monitoring will continue to be performed for similar complaints.Based on the information provided and the results of our investigation; a definitive root cause could not be determined.

• Brand Name: THREE-WAY PLASTIC STOPCOCK
• Type of Device: KGZ ACCESSORIES, CATHETER
• Manufacturer (Section D): COOK INC; 750 daniels way; bloomington IN 47404
• Manufacturer Contact: larry pool ; 750 daniels way; bloomington, IN 47404 ; 8128294891
• MDR Report Key: 6449864
• MDR Text Key: 71403050
• Report Number: 1820334-2017-00502
• Device Sequence Number: 1
• Product Code: KGZ
• UDI-Device Identifier: 00827002002197
• UDI-Public: (01)00827002002197(17)200609(10)5943715
• Combination Product (y/n): N
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: foreign,user facility
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 05/31/2017

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 Model Number: N/A
• Device Catalogue Number: PTWS-2FLL-MLL-R
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: No
• Initial Date Manufacturer Received: 03/02/2017
• Initial Date FDA Received: 03/31/2017
• Supplement Dates Manufacturer Received: Not provided
• Supplement Dates FDA Received: 05/31/2017
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 06/09/2015
• 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