MAUDE Adverse Event Report: ARROW INTERNATIONAL LLC ARROW SPINAL ANES/EPIDURAL CATH KIT; ANESTHESIA CONDUCTION CATHETER

Catalog Number	UI-05502
Medical Device Problem Codes	Break (1069); Material Separation (1562)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/02/2024
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
(b)(4).
Event or Problem Description
It was reported "twice in the last month, the catheter from this kit has broken off when being pulled out/discontinued.With the most recent occurrence (last thursday), the catheter and the internal wire broke off.These patients needed to have surgery to have the remaining part of the catheter retrieved from their backs." additional information reports "the patient was consulted with the neuro surgery team and hd to go back to the operating room to have the remainder of the catheter removed".The patient's current condition is reported as "fine".Associated mdr number includes: 9680794-2024-00523.
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.Corrected data: section d.4.- unique identifier (udi)# corrected from (b)(4).
Event or Problem Description
It was reported "twice in the last month, the catheter from this kit has broken off when being pulled out/discontinued.With the most recent occurrence (last thursday), the catheter and the internal wire broke off.These patients needed to have surgery to have the remaining part of the catheter retrieved from their backs." additional information reports "the patient was consulted with the neuro surgery team and hd to go back to the operating room to have the remainder of the catheter removed".The patient's current condition is reported as "fine".Associated mdr number includes: 9680794-2024-00523.

• Brand Name: ARROW SPINAL ANES/EPIDURAL CATH KIT
• Common Device Name: ANESTHESIA CONDUCTION CATHETER
• Manufacturer (Section D): ARROW INTERNATIONAL LLC; morrisville NC
• Manufacturer (Section G): ARROW INTERNATIONAL DE MEXICO S.A. DE C.V.; ave. washington 3701; colonia panamericana, chihuahua; chihuahua 31200 ; MX 31200
• Manufacturer Contact: katharine tarpley ; 3015 carrington mill blvd; morrisville, NC 27560
• MDR Report Key: 19459850
• Report Number: 9680794-2024-00524
• Device Sequence Number: 20826310
• Product Code: BSO
• UDI-Device Identifier: 00801902014160
• UDI-Public: 00801902014160
• Combination Product (Y/N): N
• Initial Reporter State: WI
• Initial Reporter Country: US
• PMA/510(K) Number: K140110
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: User Facility,Company Representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 05/08/2024

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?: Yes
• Device Expiration Date: 04/30/2025
• Device Catalogue Number: UI-05502
• Device Lot Number: 33F23J0523
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/08/2024
• Supplement Date Received by Manufacturer: 06/20/2024
• Initial Report FDA Received Date: 06/04/2024
• Supplement Report FDA Received Date: 06/24/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 10/11/2023
• 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: NONE REPORTED; NONE REPORTED
• Patient Sex: Unknown