MAUDE Adverse Event Report: C.R. BARD, INC. (BASD) -3006260740 3FR SL PROVENA MIDLINE MAX BARRIER KIT; MIDLINE CATHETER

Model Number	N/A
Medical Device Problem Code	Material Deformation (2976)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	06/13/2022
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported by the customer "on (b)(6) 2022 one of the members was placing a 3 french bard provena power injectable midline on a patient.The nurse had no issues cannulating the vessel but when she attempted to dilate the vessel, she noticed that she was meeting resistance with the introducer/dilator.When she inspected the introducer/dilator, she noticed that the sheath of the introducer was pealing backwards.She obtained another introducer/sheath and was able to easily finish dilating the vessel and place the midline catheter.".
Additional Manufacturer Narrative
The manufacturer has received the sample and will evaluate.Results are expected soon.A lot history review (lhr) of reft1128 showed no other similar product complaint(s) from this lot number.
Additional Manufacturer Narrative
H11: section a through f - the information provided by bd represents all of the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bd.The following were reviewed as part of this investigation:¿patient severity, applicable previous investigation(s), sample analysis, applicable fmea documents, applicable manufacturing records, and labeling.Based on a review of this information, the following was concluded: the complaint of a difficult insertion is confirmed.One 3.5 fr x 7cm microez microintroducer was returned for evaluation.The product sticker label indicated lot: reft1128.The dilator was returned, and the sheath had not been peeled.The sheath was observed to be bent at the proximal end extending from the peelable tabs and in the center region of the sheath tubing.Bunching of the sheath tip was also noted.Microscopic observation of the sheath tip revealed the material to be compressed and bunched inwards.The sheath tip taper transition did not appear to be smooth.The sheath tip surface was flat which created a blunt surface.Since the condition of the sheath tip taper likely contributed to the insertion of the device, the complaint is confirmed.Bd is working closely with the manufacturing facility to prevent reoccurrence of the reported event.
Event or Problem Description
It was reported by the customer "on (b)(6) 2022 one of the members was placing a 3 french bard provena power injectable midline on a patient.The nurse had no issues cannulating the vessel but when she attempted to dilate the vessel, she noticed that she was meeting resistance with the introducer/dilator.When she inspected the introducer/dilator, she noticed that the sheath of the introducer was pealing backwards.She obtained another introducer/sheath and was able to easily finish dilating the vessel and place the midline catheter.".

• Brand Name: 3FR SL PROVENA MIDLINE MAX BARRIER KIT
• Common Device Name: MIDLINE CATHETER
• Manufacturer (Section D): C.R. BARD, INC. (BASD) -3006260740; 605 north 5600 west; salt lake city 84116
• Manufacturer (Section G): BARD REYNOSA S.A. DE C.V. -9617592; blvd. montebello #1; parque industrial colonial; reynosa, tamaulipas 88780 ; MX 88780
• Manufacturer Contact: johanna de oliveira ; 605 north 5600 west; salt lake city 84116 ; 8015950700
• MDR Report Key: 14957665
• Report Number: 3006260740-2022-02574
• Device Sequence Number: 6915578
• Product Code: PND
• UDI-Device Identifier: 00801741153952
• UDI-Public: (01)00801741153952
• Combination Product (Y/N): N
• Initial Reporter State: PA
• Initial Reporter Country: US
• PMA/510(K) Number: K153393
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Other,User Facility
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 10/06/2022

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 Model Number: N/A
• Device Catalogue Number: S4153108D
• Device Lot Number: REFT1128
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 07/05/2022
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 06/15/2022
• Supplement Date Received by Manufacturer: 10/06/2022
• Initial Report FDA Received Date: 07/08/2022
• Supplement Report FDA Received Date: 10/07/2022
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 06/01/2021
• 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 Number: 1
• Outcome Attributed to Adverse Event: Other
• Patient Sex: Unknown