MAUDE Adverse Event Report: CONMED CORPORATION 9/32 IN (7.1MM) X 9 FT (2.7M) (20/CS); TUBE, ASPIRATING, FLEXIBLE, CONNECTING

Model Number	0037050
Medical Device Problem Code	Delivered as Unsterile Product (1421)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Event or Problem Description
During incoming inspection, the distributor rejected this device, 0037050, for an insufficient heatseal.There was no contact with the patient as this was found during incoming inspection.This will be reported as a malfunction with potential for injury upon reoccurrence.
Additional Manufacturer Narrative
Received one 0037050 unopened in original packaging.The lot number of the device was verified.A visual inspection found the packaging was returned taped to close an open hole in the seal of the packaging.The manufacturing documents from the device history record have been reviewed with special attention to the manufacturing and inspection of the product.The product released for distribution was found to have met all specifications prior to shipment.This is the only complaint for this lot number and failure mode within the past two years.A two-year review of complaint history revealed there has been a total of 36 complaints, regarding 70 devices, for this device family and failure mode.During this same time frame (b)(4) devices have been manufactured and shipped worldwide.Should all the complaint devices have been found confirmed for this reported failure, the rate of failure would be (b)(4).This issue will continue to be monitored through the complaint system to assure patient safety.
Additional Manufacturer Narrative
Corrected data: d-4 expiration date.E-1 email address.G-3.

• Brand Name: 9/32 IN (7.1MM) X 9 FT (2.7M) (20/CS)
• Common Device Name: TUBE, ASPIRATING, FLEXIBLE, CONNECTING
• Manufacturer (Section D): CONMED CORPORATION; 11311 concept blvd.; complejo industrial chihuahua; largo FL 33773
• MDR Report Key: 11747675
• Report Number: 3007305485-2021-00190
• Device Sequence Number: 19823056
• Product Code: BYY
• UDI-Device Identifier: 10653405000587
• UDI-Public: (01)10653405000587(17)240828(10)201908304
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: distributor,foreign
• Initial Reporter Occupation: Administrator/Supervisor
• Type of Report: Initial,Followup
• Report Date (Section B): 04/30/2021

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: Other
• Device Expiration Date: 08/28/2024
• Device Model Number: 0037050
• Device Catalogue Number: 0037050
• Device Lot Number: 201908304
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 03/25/2021
• Initial Date Received by Manufacturer: 03/30/2021
• Supplement Date Received by Manufacturer: 04/21/2021
• Initial Report FDA Received Date: 04/29/2021
• Supplement Report FDA Received Date: 04/30/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1