MAUDE Adverse Event Report: COVIDIEN CONTAINER 18 GAL CHEMO W SLIDE; CONTAINER, SHARPS

Model Number 8939

Device Problems Defective Component (2292); Detachment of Device or Device Component (2907)

Patient Problem No Patient Involvement (2645)

Event Date 09/20/2019

Event Type  malfunction  

Manufacturer Narrative

The incident sample has been requested but to date has not been received for evaluation.If the sample is received, or if additional information pertinent to the incident is obtained a follow-up report will be submitted.As part of our manufacturing process, all device history records are reviewed and approved by quality, prior to release of product.

Event Description

The customer reported that when they received the containers the lids would not slide and would not stay attached.

• Brand Name: CONTAINER 18 GAL CHEMO W SLIDE
• Type of Device: CONTAINER, SHARPS
• Manufacturer (Section D): COVIDIEN; 815 tek drive; crystal lake IL 60039 9002
• Manufacturer (Section G): COVIDIEN; 815 tek drive; crystal lake IL 60039 9002
• Manufacturer Contact: jill saraiva ; 15 hampshire street; mansfield, MA 02048 ; 5086183640
• MDR Report Key: 9109653
• MDR Text Key: 159866283
• Report Number: 1424643-2019-00545
• Device Sequence Number: 1
• Product Code: MMK
• UDI-Device Identifier: 40884521022769
• UDI-Public: 40884521022769
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,distri
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 09/24/2019

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: No Information
• Device Model Number: 8939
• Device Catalogue Number: 8939
• Device Lot Number: 19H00563
• Was Device Available for Evaluation?: Yes
• Initial Date Manufacturer Received: 09/20/2019
• Initial Date FDA Received: 09/24/2019
• Type of Device Usage: N
• Patient Sequence Number: 1