MAUDE Adverse Event Report: TAMBRANDS MANUFACTURING, INC L.TAMPONSORGCOTTONFULLSIZENATURALSUPERUNSCNT30CT; TAMPON, MENSTRUAL, UNSCENTED - HEB

Lot Number	4059D541154092
Medical Device Problem Code	No Apparent Adverse Event (3189)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Product investigation is in progress.
Event or Problem Description
Cord was shedding.Detached [device breakage] case narrative: consumer reported via phone that the tampon cord was shredding and detached during removal.No injury was reported.
Additional Manufacturer Narrative
Cause was traced to manufacturing.Action plan is in place.
Event or Problem Description
Cord was shedding.Detached [device breakage].Probable manufacturing cause [manufacturing issue].Case narrative: consumer reported via phone that the tampon cord was shredding and detached during removal.No injury was reported.

• Brand Name: L.TAMPONSORGCOTTONFULLSIZENATURALSUPERUNSCNT30CT
• Common Device Name: TAMPON, MENSTRUAL, UNSCENTED - HEB
• Manufacturer (Section D): TAMBRANDS MANUFACTURING, INC; 2879 hotel rd; auburn 04210
• Manufacturer (Section G): TAMBRANDS MANUFACTURING, INC; 2879 hotel rd; auburn 04210
• Manufacturer Contact: manager affairs,feminine care ; winton hill business center b; 6280 center hill avenue; cincinnati 45224
• MDR Report Key: 19619601
• Report Number: 1219109-2024-00192
• Device Sequence Number: 6954903
• Product Code: HEB
• UDI-Device Identifier: 00073010631724
• UDI-Public: (01)00073010631724
• Combination Product (Y/N): Y
• 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: Consumer
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 08/02/2024

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: Lay User/Patient
• Device Lot Number: 4059D541154092
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: Not provided
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 06/26/2024
• Supplement Report FDA Received Date: 08/14/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• 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
• Patient Sex: Female