MAUDE Adverse Event Report: TELEFLEX MEDICAL SDN. BHD. RUSCH CURVED REINFORCD CUFF ET; TUBE, TRACHEAL (W/WO CONNECTOR

Model Number	IPN040971
Medical Device Problem Code	Insufficient Device Problem Information (3190)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	09/26/2022
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Qn# (b)(4).
Event or Problem Description
It was reported that: "the doctor found inflation problem prior to use.".
Additional Manufacturer Narrative
(b)(4).The sample was returned for evaluation.A visual exam was performed and no defects were observed.Functional testing was then performed and the cuff was inflated to 25mbar using a calibrated endotest meter.No issues were encountered.The sample was then immersed in water for leak testing.No air bubbles were observed coming from the cuff , indicating no leakage.A colored water test was also conducted on the lumen to observe if there is any constriction on side arm fitting that can cause an inflation issue; however, no issues were identified.A device history record review was performed and no relevant findings were identified.The complaint of leakage could not be confirmed.No issues were found with the returned sample.
Event or Problem Description
It was reported that: "the doctor found inflation problem prior to use." no patient involvement.

• Brand Name: RUSCH CURVED REINFORCD CUFF ET
• Common Device Name: TUBE, TRACHEAL (W/WO CONNECTOR
• Manufacturer (Section D): TELEFLEX MEDICAL SDN. BHD.; perak, west malaysia
• Manufacturer (Section G): TELEFLEX MEDICAL SDN. BHD.; lot no : pt2577 jalen perusahaan; 4 kamunting industrial estate; perak, west malaysia 34600 ; MY 34600
• Manufacturer Contact: katharine tarpley ; 3015 carrington mill blvd; morrisville, NC 27560 ; 9193614124
• MDR Report Key: 15618989
• Report Number: 8040412-2022-00288
• Device Sequence Number: 20323626
• Product Code: BTR
• UDI-Device Identifier: 14026704340986
• UDI-Public: 14026704340986
• Combination Product (Y/N): N
• Initial Reporter Country: KS
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,User Facility,Company Representative,Distributor
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 09/26/2022

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: 11/28/2025
• Device Model Number: IPN040971
• Device Catalogue Number: 103902-000080
• Device Lot Number: KME20M0186
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 09/26/2022
• Supplement Date Received by Manufacturer: 11/14/2022
• Initial Report FDA Received Date: 10/17/2022
• Supplement Report FDA Received Date: 11/14/2022
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• 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
• Concomitant Medical Products and Therapy/Usage Dates: N/A.; N/A.
• Patient Sex: Unknown