MAUDE Adverse Event Report: PAJUNK GMBH MEDIZINTECHNOLOGIE SPROTTE 2.G; ANAESTHESIA CONDUCTING NEEDLE, SPINAL, SINGLE SHOT

Model Number 121251-30A

Device Problems Loss of or Failure to Bond (1068); Fracture (1260)

Patient Problems Pain (1994); No Known Impact Or Consequence To Patient (2692)

Event Date 10/19/2018

Event Type  malfunction  

Manufacturer Narrative

Event took place in (b)(6) and has been reported through (b)(4) distribution subsidiary pajunk medical produkte gmbh.Currently the data is poor and the device has not been returned/ analysed.As soon as further data will be available a follow up report will be sent in to the agency.

Event Description

Irn# (b)(4).Summarizing translation of initial reporter´s narrative: cannula got loosened from hub.

Manufacturer Narrative

Event took place in germany and has been reported through german distribution subsidiary pajunk medical produkte gmbh.Based on risk management file and clinical evaluation report file is considered as closed.- attachment: [complaint report for 389-18.Pdf].

Event Description

Irn# 591_389-18.Summarizing translation of initial reporter´s narrative: cannula got loosened from hub.

• Brand Name: SPROTTE 2.G
• Type of Device: ANAESTHESIA CONDUCTING NEEDLE, SPINAL, SINGLE SHOT
• Manufacturer (Section D): PAJUNK GMBH MEDIZINTECHNOLOGIE; karl-hall-str. 1; tuttlinger str. 7; geisingen, baden-wuerttemberg 78187 ; GM 78187
• MDR Report Key: 8045400
• MDR Text Key: 128083050
• Report Number: 9611612-2018-00037
• Device Sequence Number: 1
• Product Code: BSP
• UDI-Device Identifier: 14048223024376
• UDI-Public: 14048223024376
• Combination Product (y/n): N
• PMA/PMN Number: K911202
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,distri
• Type of Report: Initial,Followup
• Report Date: 12/14/2018

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?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 01/05/2023
• Device Model Number: 121251-30A
• Device Catalogue Number: 121251-30A
• Device Lot Number: 1237
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 10/24/2018
• Initial Date Manufacturer Received: 10/22/2018
• Initial Date FDA Received: 11/07/2018
• Supplement Dates Manufacturer Received: 10/22/2018
• Supplement Dates FDA Received: 12/14/2018
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Other