MAUDE Adverse Event Report: MEDLINE INDUSTRIES LP Medline; CATHETER,FOLEY,100%SILICONE,6FR,1.5ML,LF

Model Number	DYND11552
Medical Device Problem Code	Material Integrity Problem (2978)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/19/2023
Type of Reportable Event	Malfunction
Event or Problem Description
Catheter broke at tubing.
Additional Manufacturer Narrative
The customer reported that on 5/19/2023."foley catheter broke at end of tubing before the balloon port, catheter seemed to be leaking beforehand.Catheter removed from patient easily.Catheter sent away for product malfunction." no additional details are available at this time.It has been determined that the reported event could cause or contribute to serious injury if it were to occur.In an abundance of caution, this medwatch is being filed.If any further relevant information is identified or obtained, a supplemental medwatch will be submitted.

• Brand Name: Medline
• Common Device Name: CATHETER,FOLEY,100%SILICONE,6FR,1.5ML,LF
• Manufacturer (Section D): MEDLINE INDUSTRIES LP; three lakes drive; northfield IL 60093
• Manufacturer Contact: kelly zampella ; three lakes drive; northfield, IL 60093
• MDR Report Key: 17333735
• Report Number: 1417592-2023-00295
• Device Sequence Number: 7331317
• Product Code: EZL
• UDI-Device Identifier: 10884389034415
• UDI-Public: 10884389034415
• Combination Product (Y/N): N
• Initial Reporter Country: CA
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 07/17/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Model Number: DYND11552
• Device Catalogue Number: CATHETER,FOLEY,100%SILICONE,6F
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 06/20/2023
• Initial Report FDA Received Date: 07/17/2023
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Other
• Patient Sex: Unknown