MAUDE Adverse Event Report: MEX03 MEXICO-JUAREZ PRESOURCE SHALTONI IR PACK (SRUTB)619; RADIOGRAPHIC CONTRAST TRAY

Model Number	SAN44SRUTB
Medical Device Problem Code	Material Frayed (1262)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/12/2021
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Review of the device history record for lot# 20191112-23-sh revealed the product was finished on november 15th, 2019.No exception was recorded in the device history record that could lead to the reported incident.The average linting data is 0.150g / 10 pieces.No sample was available at the time of the investigation.According to the supplier, operating room towel is made of cotton, so cotton fiber is born.The supplier is continuously working with cardinal health to better control the linting and have implemented several measures to improve it: suctions machines have been installed in grey cloth rolling process, dyeing process and cutting process.The suction process was added before product's final folding, and workers do it according to standard operation procedure requirement.Linting test method and acceptable criteria was stipulated to see the suction results.(b)(4).In the folding process, supplier used one cloth pad under 100pieces semi-finished products to avoid linting stuck onto the products during product's transfer.Results of the investigation revealed no abnormal situation occurred in production; therefore, the root cause could not be determined.The complaint information was shared with the relevant sectors for their awareness.No action taken at this time, but the supplier will continue to monitor trends for this type of incident.
Event or Problem Description
Customer reported the surgical towel pwtb04-stm, included in this kit san44srutb are leaves fragments on the wires and catheters during arteriogram procedure.No injury or adverse effect reported.No patient demographics were provided upon request.

• Brand Name: SHALTONI IR PACK (SRUTB)619
• Common Device Name: RADIOGRAPHIC CONTRAST TRAY
• Manufacturer (Section D): MEX03 MEXICO-JUAREZ PRESOURCE; c. arcadia 1580 , col. terraza; cd.juarez , chihuahua CP 32 599; MX CP 32599
• MDR Report Key: 11639507
• Report Number: 1423537-2021-00622
• Device Sequence Number: 16919047
• Product Code: OIO
• UDI-Device Identifier: 10888439526622
• UDI-Public: 10888439526622
• Combination Product (Y/N): N
• Initial Reporter State: TX
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 04/09/2021

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 Number: SAN44SRUTB
• Device Catalogue Number: SAN44SRUTB
• Device Lot Number: 375878
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 03/12/2021
• Initial Report FDA Received Date: 04/09/2021
• Patient Sequence Number: 1