MAUDE Adverse Event Report: COVIDIEN MONOJCT 18X1-1/2 BLUNTFILL; CANNULA, SURGICAL, GENERAL & PLASTIC SURGERY

Model Number 11811022

Device Problem Nonstandard Device (1420)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 08/08/2021

Event Type  malfunction  

Manufacturer Narrative

The incident sample has been requested but to date has not been received for evaluation.If the sample is received, or if additional information pertinent to the incident is obtained a follow-up report will be submitted.As part of our manufacturing process, all device history records are reviewed and approved by quality, prior to release of product.

Event Description

The customer reported when drawing up medication with the blunt fill, a piece of the rubber stopper of the medication vial was noted at the tip of the needle.The device was not used.

• Brand Name: MONOJCT 18X1-1/2 BLUNTFILL
• Type of Device: CANNULA, SURGICAL, GENERAL & PLASTIC SURGERY
• Manufacturer (Section D): COVIDIEN; 15 hampshire street; mansfield MA 02048
• Manufacturer (Section G): COVIDIEN; 15 hampshire street; mansfield MA 02048
• Manufacturer Contact: jill saraiva ; 777 west street; mansfield, MA 02048 ; 5086183640
• MDR Report Key: 12496933
• MDR Text Key: 273316137
• Report Number: 1282497-2021-10624
• Device Sequence Number: 1
• Product Code: GEA
• UDI-Device Identifier: 10884521544826
• UDI-Public: 10884521544826
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,user f
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 09/20/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 09/20/2021
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: No Information
• Device Model Number: 11811022
• Device Catalogue Number: 11811022
• Device Lot Number: 02010002
• Was Device Available for Evaluation?: Yes
• Date Manufacturer Received: 09/13/2021
• Type of Device Usage: N
• Patient Sequence Number: 1