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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: IMPRESS®.BRAIDED; PERIPHERAL CATHETERS
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IMPRESS®.BRAIDED; PERIPHERAL CATHETERS Back to Search Results
Catalog Number 56538KA2
Medical Device Problem Code Fracture (1260)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Date of Event 04/12/2021
Type of Reportable Event Serious Injury
Additional Manufacturer Narrative
The suspect device has been returned for evaluation.A follow up will be submitted when the evaluation is complete.
 
Event or Problem Description
The account alleges during a procedure the black radiopaque tip of the catheter detached from the rest of the device.The physician used an ensnare device to retrieve the detached tip.The procedure was successful and there are no additional patient consequences to report.
 
Additional Manufacturer Narrative
The suspect device has been returned for evaluation.The complaint is confirmed.The root cause is attributed to the manufacturing process.A search of the complaint database was performed and no similar complaints for this lot number were found.The device history record was reviewed, and no exception documents were found.
 
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Brand Name
IMPRESS®.BRAIDED
Common Device Name
PERIPHERAL CATHETERS
MDR Report Key11787812
Report Number3010665433-2021-00026
Device Sequence Number3634460
Product Code DQO
UDI-Device Identifier00884450009437
UDI-Public884450009437
Combination Product (Y/N)N
Initial Reporter StateOH
Initial Reporter CountryUS
PMA/510(K) Number
K053171
Number of Events Summarized1
Summary Report (Y/N)N
Serviced by Third Party (Y/N)Unknown
Reporter Type Manufacturer
Report Source company representative,user f
Initial Reporter Occupation Other
Type of Report Initial,Followup
Report Date (Section B) 04/12/2021
1 Device was Involved in the Event
1 Patient was Involved in the Event
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? Yes
Operator of Device Health Professional
Device Expiration Date01/12/2024
Device Catalogue Number56538KA2
Device Lot NumberE2012814
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer04/23/2021
Initial Date Received by Manufacturer 04/12/2021
Supplement Date Received by Manufacturer07/19/2021
Initial Report FDA Received Date05/06/2021
Supplement Report FDA Received Date07/22/2021
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured02/01/2021
Is the Device Labeled for Single Use? (Y/N) Yes
Is This a Single-Use Device that was
Reprocessed and Reused on a Patient? (Y/N)		 No
Usage of Device Initial
Patient Sequence Number1
Outcome Attributed to Adverse Event Hospitalization; Required Intervention;
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