MAUDE Adverse Event Report: ICU MEDICAL DE MEXICO, S. DE R.L. DE C.V. SPINNING SPIROS CLOSED MALE LUER, RED CAP; SET, ADMINISTRATION, INTRAVASCULAR

Catalog Number	20130-01
Medical Device Problem Code	Fluid/Blood Leak (1250)
Health Effect - Clinical Codes	No Consequences Or Impact To Patient (2199); Chemical Exposure (2570)
Date of Event	08/28/2020
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The device is expected to be returned for evaluation.It has not been received.
Event or Problem Description
The event involves a spinning spiros® closed male luer, red cap that leaked a chemotherapy drug, docetaxel, during patient use.The medication landed on patient¿s skin and was cleaned per protocol.The healthcare provider was wearing proper ppe and there was no report of unprotected exposure to the healthcare provider.There was patient involvement but no patient harm.
Additional Manufacturer Narrative
H10: one (1) used list# 20130-01, spinning spiros (lot# 4749754), two (2) bd alaris pump sets, and one (1) non-spinning spiros (unknown list and lot) were received on august 18, 2020 and visually inspected.As received, the devices were securely connected.The spin feature of the spinning spiros was activated and spinning freely.No visible damage or anomalies were observed.The connected devices were leak tested and leakage occurred from the o-ring/poppet interface of the spinning spiros.No leaks were seen from the non-spinning spiros or the bd alaris pump sets.The reported complaint of leakage can be confirmed.The probable cause of the leaking spiros is due to a molding anomaly on the sealing surface of the poppet sub-component.The device history review for lot 4749754 was reviewed and a poppet sub-component was found that a molding anomaly on the sealing surface that can lead to leakage.Additional information in h7.The list and lot number of the device was identified as part of a voluntary recall.Icu medical is notifying affected customers via a letter requiring removal of the affected products from the market.

• Brand Name: SPINNING SPIROS CLOSED MALE LUER, RED CAP
• Common Device Name: SET, ADMINISTRATION, INTRAVASCULAR
• Manufacturer (Section D): ICU MEDICAL DE MEXICO, S. DE R.L. DE C.V.; avenida cuarzo no. 250; ensenada, b.cfa. 22790 ; MX 22790
• MDR Report Key: 10453405
• Report Number: 9617594-2020-00337
• Device Sequence Number: 11643803
• Product Code: FPA
• UDI-Device Identifier: 00840619023386
• UDI-Public: (01)00840619023386(17)250301(10)4749754
• Combination Product (Y/N): N
• Initial Reporter Country: CA
• PMA/510(K) Number: K082806
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Non-Healthcare Professional
• Remedial Action: Recall
• Type of Report: Initial,Followup
• Report Date (Section B): 07/28/2020

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: Health Professional
• Device Expiration Date: 03/01/2025
• Device Catalogue Number: 20130-01
• Device Lot Number: 4749754
• Was Device Available for Evaluation?: Yes
• Initial Date Received by Manufacturer: 07/28/2020
• Supplement Date Received by Manufacturer: 09/03/2020
• Initial Report FDA Received Date: 08/26/2020
• Supplement Report FDA Received Date: 09/18/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: BD ALARIS IV LINE; DOCETAXEL, MFR UNK; BD ALARIS IV LINE; DOCETAXEL, MFR UNK