MAUDE Adverse Event Report: C.R. BARD, INC. (COVINGTON) -1018233 LEG BAG WITH FLIP-FLO VALVE AND LATEX STRAPS, 19 OZ., STERILE; DRAIN BAG

Model Number	150319
Medical Device Problem Code	Fungus in Device Environment (2316)
Health Effect - Clinical Codes	No Consequences Or Impact To Patient (2199); No Known Impact Or Consequence To Patient (2692)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The investigation is still in progress.Once the investigation is complete a supplemental report will be filed.
Event or Problem Description
It was reported that the customer believed the bags received from liberator medical are thinner and lower quality than those received from vitality.Customer also stated that the packaging materials were low grade cardboard boxes and subpar tape which made him uncomfortable opening the boxes as they could be exposed to covid19 virus.Per additional information received via phone on 28jul2020, one of the bags had a mold like substance growing inside.
Event or Problem Description
It was reported that the customer believed the bags received from liberator medical are thinner and lower quality than those received from vitality.Customer also stated that the packaging materials were low grade cardboard boxes and subpar tape which made him uncomfortable opening the boxes as they could be exposed to covid19 virus.Per additional information received via phone on 28jul2020, one of the bags had a mold like substance growing inside.
Additional Manufacturer Narrative
The reported event was inconclusive.No sample was returned for evaluation.A potential root cause for this failure could be "defective components from the supplier".The lot number was unknown; therefore, the device history record could not be reviewed.The instructions for use were found adequate and state the following: "directions for use: 1.Separate notches within circles.Pull straps through holes and around leg.2.Position bag on leg with flutter valve at top.3.Attach catheter or extension tubing* to top inlet.When wearing bag below knee, attach bard extension tubing* (catalog no.150615 or 4a4194).4.To empty dispoz-a-bag, push green lever on flip-flo valve out and down.Important: be sure to reclose flip-flo valve after emptying bag.5.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." corrections: d10, h3.H11:section a through f - the information provided by bd represents all of the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bd.H3 other text : the device was not returned.

• Brand Name: LEG BAG WITH FLIP-FLO VALVE AND LATEX STRAPS, 19 OZ., STERILE
• Common Device Name: DRAIN BAG
• Manufacturer (Section D): C.R. BARD, INC. (COVINGTON) -1018233; 8195 industrial blvd; covington GA 30014
• MDR Report Key: 10431829
• Report Number: 1018233-2020-05300
• Device Sequence Number: 19446089
• Product Code: KNX
• UDI-Device Identifier: 00801741050794
• UDI-Public: (01)00801741050794
• Combination Product (Y/N): N
• Initial Reporter State: MA
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: other
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 11/28/2020

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: 150319
• Device Catalogue Number: 150319
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 07/28/2020
• Supplement Date Received by Manufacturer: 11/05/2020
• Initial Report FDA Received Date: 08/20/2020
• Supplement Report FDA Received Date: 11/28/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1