MAUDE Adverse Event Report: MEDLINE NAMIC; LHK,-,WUESTHOFF HEALTH SYSTEM,ROCKLEDGE

Catalog Number	6016745541
Medical Device Problem Code	Connection Problem (2900)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	06/26/2024
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported the control syringe would not "thread properly onto manifold" requiring them to "switch out for all new manifold during procedure".
Additional Manufacturer Narrative
It was reported the control syringe would not "thread properly onto manifold" requiring them to "switch out for all new manifold during procedure".The customer reported the incident led to "contrast mixed with blood" to be "injected all over field and equipment" and the procedure time was lengthened.To date, no information has been received to indicate that a user or a patient experienced a death, serious injury, medical intervention, follow-up care, or other adverse health impact associated with the reported problem/issue.In an abundance of caution, and in response to an fda 483 issued for cfn 1417592 on 22-jan-2024, this medwatch is being filed for the reported problem/issue.If additional relevant information becomes available a supplemental medwatch will be filed.

• Common Device Name: LHK,-,WUESTHOFF HEALTH SYSTEM,ROCKLEDGE
• Manufacturer (Section D): MEDLINE NAMIC; 10 glen falls technical park d; glens falls NY 12801
• Manufacturer Contact: danielle tognocchi ; three lakes dr; northfield, IL 60093-2753
• MDR Report Key: 19822280
• Report Number: 3015910259-2024-00023
• Device Sequence Number: 18365660
• Product Code: OEZ
• UDI-Device Identifier: 20193489179474
• UDI-Public: 20193489179474
• Combination Product (Y/N): N
• Initial Reporter State: FL
• 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 Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 07/24/2024

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
• Operator of Device: Health Professional
• Device Catalogue Number: 6016745541
• Device Lot Number: 0000106439
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 07/15/2024
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 06/26/2024
• Initial Report FDA Received Date: 07/24/2024
• 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