MAUDE Adverse Event Report: EDWARDS LIFESCIENCES, PR SWAN-GANZ DOUBLE LUMEN MONITORING CATHETER; CATHETER, INTRAVASCULAR, DIAGNOSTIC

Model Number	110F5
Medical Device Problem Code	Material Puncture/Hole (1504)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/09/2022
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that, the packaging on these 2 swan-ganz catheters from the same lot number were observed to have puncture-like holes and what looks like condensation marks.Images were provided by the customer.There was no patient injury reported.The customer shared that there were multiple devices that had the same issue.As a result of the issue found, the customer pulled their model 123f6p and 110f5 swan-ganz catheters and inspected them all for holes in the packaging.The issue was resolved by switching to a non-edwards brand pulmonary artery catheter.
Additional Manufacturer Narrative
The device evaluations are anticipated.However, the complaint cannot not be confirmed without the completion of a product evaluation.A supplemental report will be forthcoming with the evaluation results when received.A device history record review was completed and documented that device met all specifications upon distribution.Devices not returned.
Additional Manufacturer Narrative
The product is no longer available, as it was lost in transportation per the shipping company.Should the product be found and returned, the complaint will be reopened and a supplemental of the evaluation results will be sent.The complaint will be closed as no product return.Complaint histories for all reported events are reviewed against trending control limits on a monthly basis and any excursions above the control limits are assessed and documented as a part of the monthly review.

• Brand Name: SWAN-GANZ DOUBLE LUMEN MONITORING CATHETER
• Common Device Name: CATHETER, INTRAVASCULAR, DIAGNOSTIC
• Manufacturer (Section D): EDWARDS LIFESCIENCES, PR; state rd indus pk 402 km 1.4; anasco PR 00610
• Manufacturer (Section G): EDWARDS LIFESCIENCES, PR; state rd indus pk 402 km 1.4; anasco PR 00610
• Manufacturer Contact: jessica atallah ; 1 edwards way; irvine, CA 92614 ; 9492500294
• MDR Report Key: 14015239
• Report Number: 2015691-2022-04838
• Device Sequence Number: 17382828
• Product Code: DQO
• UDI-Device Identifier: 50690103000264
• UDI-Public: (01)50690103000264(17)230811(11)210811(10)63916772
• Combination Product (Y/N): N
• Initial Reporter State: NJ
• Initial Reporter Country: US
• PMA/510(K) Number: PREAMENDMEN
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional,User Facility
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 05/06/2022

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 Expiration Date: 08/11/2023
• Device Model Number: 110F5
• Device Lot Number: 63916772
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 03/09/2022
• Supplement Date Received by Manufacturer: 05/02/2022
• Initial Report FDA Received Date: 04/05/2022
• Supplement Report FDA Received Date: 05/07/2022
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 08/11/2021
• 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 Number: 1
• Patient Sex: Unknown