MAUDE Adverse Event Report: B. BRAUN MEDICAL INC. PERIFIX®; EPIDURAL ANESTHESIA KIT

Catalog Number	332079
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	Foreign Body In Patient (2687)
Date of Event	06/20/2024
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
This report has been identified as b.Braun medical internal report number (b)(4).The investigation is ongoing at this time.A follow-up will be submitted when the investigation results become available.
Event or Problem Description
As reported by user facility: brief inquiry description: fx catheter removal incomplete.Detailed inquiry description: a portion of fx catheter remained inside patient.Description of the patient event: upon attempted removal of fx catheter, a portion remained inside patient live call received on (b)(6) 2024: on (b)(6) 2024 patient was in labor and delivery.Staff administered an epidural and not problems putting the catheter in but once they went to remove it part of the device stayed in the patient as it had broken off.The device was noted to be frayed and threaded out.The patient was able to deliver and there was no impact to the childbirth.Patient being transferred to a neurosurgeon to see if he can remove the device (may have been transferred last night or may go today).It is unknown if she will be number locally or if she has to go under anesthesia.The reporter does not have any idea clinically how this will be performed.Reporter will provide additional information regarding the attempt to remove and the patient status after the procedure.
Additional Manufacturer Narrative
This report has been identified as b.Braun medical internal report number (b)(4).One unopened and one used sample was provided for evaluation.Upon visual inspection of the returned sample, the used catheter showed to be damaged and sheared.The unused catheter from the unopened kit was pull tested and the coil was measured with passing results.Per the manufacturers investigation, this defect is not likely to have happened during the manufacturing process.It is believed to have happened during application.A review of the discrepancy management system (dsms) database was performed for the reported lot number and no abnormalities or non-conformances were noted during the in process or final product inspection.We will maintain this report for further references and continue to monitor other reports for similar occurrences.If any additional pertinent information becomes available, a follow up will be submitted.

• Brand Name: PERIFIX®
• Common Device Name: EPIDURAL ANESTHESIA KIT
• Manufacturer (Section D): B. BRAUN MEDICAL INC.; 901 marcon blvd; allentown PA 18109
• Manufacturer Contact: jonathan severino ; 901 marcon blvd; allentown, PA 18109 ; 4847197287
• MDR Report Key: 19655972
• Report Number: 2523676-2024-00648
• Device Sequence Number: 6623950
• Product Code: OGE
• UDI-Device Identifier: 04046964177224
• UDI-Public: (01)04046964177224
• Combination Product (Y/N): N
• Initial Reporter State: AL
• 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,User Facility
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 11/18/2024

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: Health Professional
• Device Expiration Date: 08/31/2025
• Device Catalogue Number: 332079
• Device Lot Number: 0061927941
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 06/21/2024
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 07/02/2024
• Supplement Report FDA Received Date: 11/18/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 03/25/2024
• 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