MAUDE Adverse Event Report: ARGON MEDICAL DEVICES F8 SKATER DRAIN CATH. STRING

Model Number	755108035E
Medical Device Problem Code	Fluid/Blood Leak (1250)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/13/2023
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
A review of the manufacturing and inspection records for this lot was conducted, and no deviations and non-conformances were recorded.According to the product experience report, sample not available to returned and the complaint was not confirmed, so no corrective action is required at this time.If the sample is returned at a future date, this complaint may be reopened for further evaluation at that time.
Event or Problem Description
Physician reports that in the connector of the implanted catheter, through the hole where its anchor thread passes, the liquid that the catheter is draining also comes out; because that outlet hole is not well sealed and the internal valve of the catheter does not work either.The result is that the doctor must change the catheter and is a danger because of the great possibility of infections of the area where the catheter comes out.Obtaining samples from the failed catheters explanted is practically impossible due to the great possibility of dangerous biocontamination during the handling of the rescued devices.Obtaining samples from the failed catheters explanted is practically impossible due to the great possibility of dangerous biocontamination during the handling of the rescued devices.

• Brand Name: F8 SKATER DRAIN CATH. STRING
• Common Device Name: SKATER
• Manufacturer (Section D): ARGON MEDICAL DEVICES; 1445 flat creek rd; athens TX 75751
• Manufacturer Contact: elnaz rahman ; 1445 flat creek rd; athens, TX 75751 ; 9036759321
• MDR Report Key: 17049872
• Report Number: 0001625425-2023-01078
• Device Sequence Number: 3480079
• Product Code: GBQ
• UDI-Device Identifier: 00886333000166
• UDI-Public: 00886333000166
• Combination Product (Y/N): N
• Initial Reporter Country: SP
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Distributor
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 06/02/2023

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: 755108035E
• Device Catalogue Number: 755108035
• Device Lot Number: 11451034
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/23/2023
• Initial Report FDA Received Date: 06/02/2023
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 11/28/2022
• 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: Required Intervention; Other
• Patient Sex: Unknown