MAUDE Adverse Event Report: MEDLINE INDUSTRIES LP; TRAY,FOLEY,SILVER,2-WAY,14FR,10ML,LF

Catalog Number	DYND140214
Medical Device Problem Code	Appropriate Device Problem Term/Code Not Available (3191)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	05/30/2024
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
According to facility the foley catheter was placed and "the patient was able to urinate around foley approximately 1 minute after placement, subsequently the foley fell out and was replaced with another foley kit".No additional information is available at this time.A sample was returned for evaluation and at this time a definitive root cause cannot be determined as there were not reported functional or visual abnormalities noted.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.
Event or Problem Description
According to facility the foley catheter was placed and "the patient was able to urinate around foley approximately 1 minute after placement, subsequently the foley fell out and was replaced with another foley kit".

• Common Device Name: TRAY,FOLEY,SILVER,2-WAY,14FR,10ML,LF
• Manufacturer (Section D): MEDLINE INDUSTRIES LP; three lakes drive; northfield IL 60093
• Manufacturer Contact: justin herrmann ; three lakes dr; northfield, IL 60093
• MDR Report Key: 19597047
• Report Number: 1417592-2024-00678
• Device Sequence Number: 8493772
• Product Code: OHR
• UDI-Device Identifier: 10080196183012
• UDI-Public: 10080196183012
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• 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): 06/24/2024

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?: No
• Device Catalogue Number: DYND140214
• Device Lot Number: 23LBK180, 24CBH882
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 06/10/2024
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/30/2024
• Initial Report FDA Received Date: 06/24/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• 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