MAUDE Adverse Event Report: ARROW CVC KIT: 14GA X 20CM; CATHETER INTRAVASCULAR THERAPE

Model Number IPN031223

Device Problem Fluid/Blood Leak (1250)

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

Event Date 09/06/2021

Event Type  malfunction  

Manufacturer Narrative

(b)(4).

Event Description

It was reported that "the puncture needle is leaking - aspiration is not possible, when the needle is flushed it comes out from the sides." no patient harm reported.

Event Description

It was reported that "the puncture needle is leaking - aspiration is not possible, when the needle is flushed it comes out from the sides." no patient harm reported.

Manufacturer Narrative

(b)(4).Complaint verification testing could not be performed as it was reported that the sample is not available for return.A device history record review was performed and no relevant findings were identified.Without the device to evaluate the complaint could not be confirmed and the probable cause could not be determined from the available information.Teleflex will continue to monitor and trend for reports of this nature.

• Brand Name: ARROW CVC KIT: 14GA X 20CM
• Type of Device: CATHETER INTRAVASCULAR THERAPE
• MDR Report Key: 12546030
• MDR Text Key: 273751520
• Report Number: 3006425876-2021-00882
• Device Sequence Number: 1
• Product Code: FOZ
• Combination Product (y/n): N
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,foreig
• Type of Report: Initial,Followup
• Report Date: 09/06/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 09/29/2021
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: No Information
• Device Expiration Date: 12/31/2022
• Device Model Number: IPN031223
• Device Catalogue Number: DE-24701-ELOG
• Device Lot Number: 71F21C0581
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 10/22/2021
• Was Device Evaluated by Manufacturer?: Device Not Returned to Manufacturer
• Date Device Manufactured: 03/09/2021
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1