MAUDE Adverse Event Report: ICU MEDICAL DE MEXICO, S. DE R.L. DE C.V. TEGO¿ CONNECTOR; SET, ADMINISTRATION, INTRAVASCULAR

Catalog Number	D1005
Medical Device Problem Code	Crack (1135)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	09/09/2024
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that a tego¿ connector was found to have a crack during patient use.It was stated in the report that the best guess of lot number as the cap cracked 7 days after it was applied to the patient.Appropriate actions were taken by the nursing staff with the replacement of the broken tego cap.This is a known issue when patients have multiple days of chemotherapy, and the spiros closed system drug-transfer device (cstd) caps are twisted on and off the tego cap repeatedly.Appears the spiros caps wear down the tego luer lock connector.Mitigation strategies are limited due to the requirement of both pieces of equipment/caps.It has the potential to change tego caps more frequently in patients requiring multiple chemo days.There was no patient harm reported.
Additional Manufacturer Narrative
The device was returned for evaluation; however, testing has not yet been completed.
Additional Manufacturer Narrative
Received one used d1005 tego for inspection.As received, the seal had been torn around the posts on either side.A crack was observed on the body of the tego.The parts have no sign of flowlines, no void or defects and there is no sign of splay or crazing.The gate area is free of any signs of defect, no gate blush, or signs of jetting.No discoloration that would indicate fluctuation in processing temperature.No mating device was returned for evaluation.The complaint of cracks can be confirmed.The probable cause is unknown.It is unknown how the chemo could interact with the chemo body and if the chemo could lead to the breakage.The tego has not been tested to understand the durability with chemotherapy drugs.Tego is intended for use as an accessory to a vascular access device (catheter) used in hemodialysis and apheresis applications or as an accessory to an intravascular administration set for the administration or withdrawal of fluids to a patient through a cannula or needle placed in the vein or artery.The lot history was reviewed, no nonconformities were identified that may have contributed to the reported complaint.

• Brand Name: TEGO¿ CONNECTOR
• Common Device Name: SET, ADMINISTRATION, INTRAVASCULAR
• Manufacturer (Section D): ICU MEDICAL DE MEXICO, S. DE R.L. DE C.V.; avenida cuarzo no. 250; ensenada, b.cfa. 22790 ; MX 22790
• Manufacturer Contact: reed covert ; 600 n. field dr.; lake forest, IL 60045 ; 2247062300
• MDR Report Key: 20579417
• Report Number: 9617594-2024-01545
• Device Sequence Number: 8650302
• Product Code: FPA
• UDI-Device Identifier: 00840619069216
• UDI-Public: (01)00840619069216(17)290501(10)13998225
• Combination Product (Y/N): N
• Initial Reporter State: MN
• Initial Reporter Country: US
• PMA/510(K) Number: K053106
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional,Company Representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 12/19/2024

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 Catalogue Number: D1005
• Device Lot Number: 13998225
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 10/09/2024
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 10/02/2024
• Supplement Date Received by Manufacturer: 11/22/2024
• Initial Report FDA Received Date: 10/31/2024
• Supplement Report FDA Received Date: 12/19/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 05/01/2024
• 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: Unknown