MAUDE Adverse Event Report: ARROW MEDSOURCE GROUP LIMITED TUBING, SUCTION, CONNECTOR, 3/16" X 6' (5 MM X 1.8 M); TUBE, ASPIRATING, FLEXIBLE, CONNECTING

Model Number	71-C506
Medical Device Problem Code	Fitting Problem (2183)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	01/01/2025
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
A user facility reported, "tubing does not fit securely onto their endoscopes.The 71-c506 does not stay secure." deroyal industries requested return of the device but it has yet to be returned.A supplier corrective action request (scar) has been issued to the supplier.This investigation is not complete at this time.No further information is available at this time.We will provide follow-up report when additional information is available.
Event or Problem Description
A user facility reported, "tubing does not fit securely onto their endoscopes.The 71-c506 does not stay secure.".
Additional Manufacturer Narrative
A user facility reported, "tubing does not fit securely onto their endoscopes.The 71-c506 does not stay secure." deroyal industries requested return of the device but it has yet to be returned.Deroyal industries was not able to complete an inventory check as no inventory was available on hand from this lot.No failure modes and effects analysis could be reviewed by deroyal as this is a purchased product.Deroyal did review corrective and preventive actions but none were related to this product.Deroyal ran a complaint to sales ratio for this product from january 2023 to january 2025 and found it to be (b)(4).The scar was returned after the supplier completed their investigation.The supplier pulled their existing inventory and randomly sampled (b)(4) eaches of tubing.Four products were found to be too deep.Root cause: the supplier determined the root cause to be a manufacturing/ quality control issue.The assembly staff were found to have improper force control during installation which resulted in an inconsistent depth.Corrective and preventive actions: the supplier took several corrective and preventive actions due to this root cause.The connector limit line was increased from 0.15mm to 0.75mm.The work instruction book was also updated to change the feed and process inspection instructions and add the measurement of the joint stop line and joint depth.This change in the process was then retrained for applicable staff to ensure compliance to the new joint assembly changes.These corrections were then confirmed to be effective through their process qualification showing the new depth of the pipe was effective.Deroyal industries initiated a recall to remove products from the field that were manufactured prior to the corrections made by the supplier/manufacturer.Deroyal will continue to monitor for trends around this item and issue.The investigation is complete at this time.No further information is available at this time.We will provide follow-up report if additional information becomes available.

• Brand Name: TUBING, SUCTION, CONNECTOR, 3/16" X 6' (5 MM X 1.8 M)
• Common Device Name: TUBE, ASPIRATING, FLEXIBLE, CONNECTING
• Manufacturer (Section D): ARROW MEDSOURCE GROUP LIMITED; unit 1104, yueda 889 center; 1111 changshou rd, jingan; shanghai, ; CH
• Manufacturer (Section G): DEROYAL INDUSTRIES, INC.; 1703 highway 33 south; new tazewell TN 37825
• Manufacturer Contact: reagan newman ; 200 debusk lane; powell, TN 37849 ; 8653622106
• MDR Report Key: 21160088
• Report Number: 1060680-2025-00008
• Device Sequence Number: 7573297
• Product Code: BYY
• UDI-Device Identifier: 00749756579032
• UDI-Public: 00749756579032
• Combination Product (Y/N): N
• Initial Reporter State: MN
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: User Facility
• Initial Reporter Occupation: Non-Healthcare Professional
• Remedial Action: Recall
• Type of Report: Initial,Followup
• Report Date (Section B): 05/28/2025

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 Model Number: 71-C506
• Was Device Available for Evaluation?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 01/06/2025
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 01/15/2025
• Supplement Report FDA Received Date: 05/28/2025
• 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: Unknown