MAUDE Adverse Event Report: TAMBRANDS MANUFACTURING, INC TAMPAXTAMPONSBASEOEFOPENENDEDREGNORUNSCNT54CT; TAMPON, MENSTRUAL, UNSCENTED - HEB

Lot Number	4219243054 40 05:20
Medical Device Problem Codes	Adverse Event Without Identified Device or Use Problem (2993); Insufficient Device Problem Information (3190)
Health Effect - Clinical Code	Foreign Body In Patient (2687)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Product investigation is in progress.
Event or Problem Description
Tampon coming apart inside my vagina.Fragments remain inside [foreign body in reproductive tract].Tampon coming apart inside my vagina [device breakage].Case narrative: consumer reported via email that the tampon came apart inside of her vagina.No serious injury was reported.
Additional Manufacturer Narrative
No failure could be identified as a result of the investigation.
Event or Problem Description
Tampon coming apart inside my vagina.Fragments remain inside [foreign body in reproductive tract] tampon coming apart inside my vagina [device breakage] case narrative: consumer reported via email that the tampon came apart inside of her vagina.No serious injury was reported.

• Brand Name: TAMPAXTAMPONSBASEOEFOPENENDEDREGNORUNSCNT54CT
• 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 POST
• Manufacturer Contact: manager affairs,feminine care ; winton hill business center b; 6280 center hill avenue; cincinnati 45224
• MDR Report Key: 21276832
• Report Number: 1219109-2025-00036
• Device Sequence Number: 17050878
• Product Code: HEB
• UDI-Device Identifier: 00073010006164
• UDI-Public: (01)00073010006164
• Combination Product (Y/N): Y
• Initial Reporter Country: CA
• PMA/510(K) Number: K061486
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,Consumer
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 03/10/2025

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?: Yes
• Operator of Device: Lay User/Patient
• Device Lot Number: 4219243054 40 05:20
• Was Device Available for Evaluation?: No
• 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: 01/30/2025
• Supplement Report FDA Received Date: 03/11/2025
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• 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 Age: 27 YR
• Patient Sex: Female