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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: TELEFLEX MEDICAL CASTROVIEJO NH 8" TC; INSTRUMENTS, SURGICAL, CARDIO

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TELEFLEX MEDICAL CASTROVIEJO NH 8" TC; INSTRUMENTS, SURGICAL, CARDIO Back to Search Results
Model Number IPN005932
Medical Device Problem Code Break (1069)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 03/14/2021
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
(b)(4).The device has not been returned for investigation.Teleflex will continue to monitor and trend related events.
 
Event or Problem Description
Broken jaw, tip not aligned and not biting properly.
 
Event or Problem Description
Broken jaw, tip not aligned and not biting properly.
 
Additional Manufacturer Narrative
Qn# (b)(4).Device history record was reviewed for notifications pertaining to incoming inspection, stock checks, and product returns.No concerns were noted with reference to 354965.(1) sample of 354965 lot g9 was received for evaluation.Due to the repetitive and isolated nature of the complaint the samples were reviewed in aggregate to better understand the root cause.Visual review of the samples noted that the samples represented a multiple states of failure.The broken jaws were examined under magnification and stress fractures and rust were noted on the broken surfaces.Several samples showed the jaw still attached with hairline cracks to partially detached.One sample in particular was physically bent behind the boxlock and the nature of the failure suggests tray damage was a factor.The stress fractures noted indicate that a oversized needle may have been used which was beyond the capacity of the device.Isolated and site specific.The samples provided indicate that tray damage and oversized needles may have played a role in the observed damage.(1) sample of 354965 lot g9 was received for evaluation.Due to the repetitive and isolated nature of the complaint the samples were reviewed in aggregate to better understand the root cause.Visual review of the samples noted that the samples represented a multiple states of failure.The broken jaws were examined under magnification and stress fractures and rust were noted on the broken surfaces.Several samples showed the jaw still attached with hairline cracks to partially detached.One sample in particular was physically bent behind the boxlock and the nature of the failure suggests tray damage was a factor.The stress fractures noted indicate that a oversized needle may have been used which was beyond the capacity of the device.A dimensional inspection was not required as part of this investigation.A functional inspection was not required as part of this investigation.Multiple complaints were implicated for the same product code from the same facility.Reference 20038603, 20038613, 20038642, 20038643, 20038644, 20038645, 20038646, 20038647 no confirmed complaints were received in this range with the same issue.Sap was reviewed for notifications pertaining to incoming inspection, stock checks, and product returns.No concerns were noted with reference to 354965 isolated and site specific.The samples provided indicate that tray damage and oversized needles may have played a role in the observed damage.
 
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Brand Name
CASTROVIEJO NH 8" TC
Common Device Name
INSTRUMENTS, SURGICAL, CARDIO
Manufacturer (Section D)
TELEFLEX MEDICAL
morrisville NC
MDR Report Key11603362
Report Number3011137372-2021-00092
Device Sequence Number11850244
Product Code DWS
UDI-Device Identifier24026704522129
UDI-Public24026704522129
Combination Product (Y/N)N
Initial Reporter CountryRP
Number of Events Summarized1
Summary Report (Y/N)N
Serviced by Third Party (Y/N)N
Reporter Type Manufacturer
Report Source foreign,health professional
Initial Reporter Occupation Other
Type of Report Initial,Followup
Report Date (Section B) 03/18/2021
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 Model NumberIPN005932
Device Catalogue Number354965
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer05/05/2021
Initial Date Received by Manufacturer 03/18/2021
Supplement Date Received by Manufacturer05/17/2021
Initial Report FDA Received Date04/01/2021
Supplement Report FDA Received Date05/18/2021
Is This a Single-Use Device that was
Reprocessed and Reused on a Patient? (Y/N)
No
Patient Sequence Number1
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