MAUDE Adverse Event Report: C.R. BARD, INC. (COVINGTON) -1018233 BARDIA CLOSED SYSTEM URINARY DRAINAGE BAG WITH ANTI-REFLUX CHAMBER AND STRAP; DRAIN BAG

Model Number	802002
Medical Device Problem Code	Partial Blockage (1065)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The device was not returned for evaluation.The reported event is inconclusive.A potential failure mode could be ¿does not allow for urine drainage¿.A potential root cause for this failure could be "occlusions".The lot number is unknown; therefore, the device history record could not be reviewed.The instructions for use were found adequate and state the following: ¿directions for use: wash hands.Remove protective cap from drainage tube and connect drainage tube adapter to catheter.Fasten drainage bag to bedframe near the foot of the bed.Do not allow bag to touch floor.Important: hang drainage tube in a straight fashion from bedside to drainage bag.If drainage bag is placed even with patient¿s hip, coil tubing alongside patient.Tubing should be draped over patient¿s leg.Check that urine is draining into bag.To empty bag: a.Remove outlet tube from housing.Release clamp and empty bag.When bag is empty, return clamp to closed position and replace tube in housing.Note: if specimen is required, see directions for obtaining urine sample.Wash hands.After use, this product may be a potential biohazard.Handle and dispose of in accordance with accepted medical practice and applicable local, state and federal laws and regulations.Directions for obtaining urine sample: kink tubing a minimum of 3 inches below sample sleeve until urine is under sample site.Swab surface of puncture site with antiseptic wipe.Insert needle (21g or smaller) through center of puncture site.Be careful to avoid puncturing opposite side of sample sleeve.Remove desired volume of urine.Release kink to permit flow to drainage bag.Send specimen to laboratory.".
Event or Problem Description
It was reported that the drain bag had a plastic that blocked the urine from entering into the drain bag, which caused the bag to leak.

• Brand Name: BARDIA CLOSED SYSTEM URINARY DRAINAGE BAG WITH ANTI-REFLUX CHAMBER AND STRAP
• Common Device Name: DRAIN BAG
• Manufacturer (Section D): C.R. BARD, INC. (COVINGTON) -1018233; 8195 industrial blvd; covington GA 30014
• MDR Report Key: 10279892
• Report Number: 1018233-2020-04551
• Device Sequence Number: 1073812
• Product Code: KNX
• UDI-Device Identifier: 00801741040757
• UDI-Public: (01)00801741040757
• Combination Product (Y/N): N
• Initial Reporter State: FL
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: consumer,distributor,other
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 07/15/2020

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
• Operator of Device: Lay User/Patient
• Device Model Number: 802002
• Device Catalogue Number: 802002
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 06/27/2020
• Initial Report FDA Received Date: 07/15/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1