MAUDE Adverse Event Report: ARROW INTERNATIONAL LLC ARROW VESSEL CATH SET: 24 GA X 9CM; CATHETER, PERCUTANEOUS

Catalog Number	ES-04650
Medical Device Problem Code	Deformation Due to Compressive Stress (2889)
Health Effect - Clinical Code	Insufficient Information (4580)
Date of Event	11/08/2023
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(4).
Event or Problem Description
It was reported that: the physician inserted the introducer needle in femoral vein and advanced the guidewire and the catheter over the wire without any problems.When she retrieved the guidewire, the catheter kinks and comes out together with the guidewire.She then inserted it successfully in the jugular vein after 3 attempts.She used a 22 ga in jugular vein.Associated complaints 3006425876-2023-01175 and 3006425876-2023-01176.
Additional Manufacturer Narrative
(b)(4).Complaint verification testing could not be performed as it was reported that the sample is not available for return.A device history record review was performed and no relevant findings were identified.Without the device to evaluate the complaint could not be confirmed and the probable cause could not be determined from the available information.Teleflex will continue to monitor and trend for reports of this nature.
Event or Problem Description
It was reported that: the physician inserted the introducer needle in femoral vein and advanced the guidewire and the catheter over the wire without any problems.When she retrieved the guidewire, the catheter kinks and comes out together with the guidewire.She then inserted it successfully in the jugular vein after 3 attempts.She used a 22 ga in jugular vein.Associated complaints 3006425876-2023-01177, 3006425876-2023-01175 and 3006425876-2023-01176.
Event or Problem Description
It was reported that: the physician inserted the introducer needle in femoral vein and advanced the guidewire and the catheter over the wire without any problems.When she retrieved the guidewire, the catheter kinks and comes out together with the guidewire.She then inserted it successfully in the jugular vein after 3 attempts.She used a 22 ga in jugular vein.Associated complaints 3006425876-2023-01177, 3006425876-2023-01175 and 3006425876-2023-01176.
Additional Manufacturer Narrative
(b)(4).In section d provided the full udi # udi related data quality updates only.

• Brand Name: ARROW VESSEL CATH SET: 24 GA X 9CM
• Common Device Name: CATHETER, PERCUTANEOUS
• Manufacturer (Section D): ARROW INTERNATIONAL LLC; morrisville NC
• Manufacturer (Section G): ARROW INTERNATIONAL CR, A.S.; jamska 2359/47; zdar nad sazavou 591 0 1; EZ 591 01
• Manufacturer Contact: marling heaton ; 3015 carrington mill blvd; morrisville, NC 27560
• MDR Report Key: 18299463
• Report Number: 3006425876-2023-01177
• Device Sequence Number: 15243928
• Product Code: DQY
• UDI-Device Identifier: 00801902009913
• UDI-Public: (01)00801902009913(11)211012(17)250831(10)71F21K0479(21)
• Combination Product (Y/N): N
• Initial Reporter Country: SF
• PMA/510(K) Number: K810962
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,User Facility,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 11/14/2023

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 Expiration Date: 08/31/2025
• Device Catalogue Number: ES-04650
• Device Lot Number: 71F21K0479
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 11/14/2023
• Supplement Date Received by Manufacturer: 01/02/2024; Not provided
• Initial Report FDA Received Date: 12/11/2023
• Supplement Report FDA Received Date: 01/03/2024; 07/25/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 10/12/2021
• 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
• Concomitant Medical Products and Therapy/Usage Dates: NOT REPORTED; NOT REPORTED; NOT REPORTED
• Patient Sex: Unknown