MAUDE Adverse Event Report: COVIDIEN LLC MAHURKAR; CATHETER, HEMODIALYSIS, IMPLANTED

Model Number	8888145001
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	01/26/2025
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.Medtronic will submit a supplemental report if additional relevant information becomes known.
Event or Problem Description
According to the reporter, during use, it was found that the blue (venous) luer adapter was cracked and had a leak.There was nothing unusual observed on the device prior to use.Flushing was done with no abnormality.The catheter was not repaired, and tego was not utilized.Maokang iodophor liquid was the cleaning agent used on the device.The insertion site was not treated prior to product placement.There were no other products being utilized with the device.There was no excessive force use on the device, and no instrument was used to loosen or tighten the device.Besides the reported issue, there were no other visible defects/damages found on the product at the time of the event.The reported product was replaced as a remedial action done, and intervention/treatment required as a result of the event.There was no blood loss, and blood transfusion was not required due to the event.The treatment did not proceed and was not completed.There was no reported patient injury.
Additional Manufacturer Narrative
Additional information: g3, h3, h6 correction: b5, d6b, e1(facility name), e1(street 1, region - removed) h3 evaluation summary: medtronic conducted an investigation based upon all information received.The device was not returned, but a photo was available for evaluation.Visual inspection noted that the luer adapter was cracked.It was reported that the luer adapter had a crack and a hole.The reported issue was confirmed.The product analysis noted evidence that the device was not used as intended.This issue can occur from overtightening the luer adapter.The manufacturing records for each device are thoroughly reviewed prior to release to ensure that it meets all medtronic quality specifications.Medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.Medtronic will submit a supplemental report if additional relevant information becomes known.
Event or Problem Description
According to the reporter, during use, it was found that the blue (venous) luer adapter was cracked and had a leak.There was nothing unusual observed on the device prior to use.Flushing was done with no abnormality.The catheter was not repaired, and tego was not utilized.Iodophor liquid was the cleaning agent used on the device.The insertion site was not treated prior to product placement.There were no other products being utilized with the device.There was no excessive force use on the device, and no instrument was used to loosen or tighten the device.Besides the reported issue, there were no other visible defects/damages found on the product at the time of the event.There was no blood loss, and blood transfusion was not required due to the event.The reported product was replaced as a remedial action done, and intervention/treatment was required as a result of the event.The treatment proceeded and was completed after the remedial action was done.There was no reported patient injury.

• Brand Name: MAHURKAR
• Common Device Name: CATHETER, HEMODIALYSIS, IMPLANTED
• Manufacturer (Section D): COVIDIEN LLC; 15 hampshire st; mansfield MA 02048
• Manufacturer (Section G): COVIDIEN LLC; 15 hampshire st; mansfield MA 02048
• Manufacturer Contact: justin ellis ; 8200 coral sea st ne; mounds view, MN 55112 ; 7635265677
• MDR Report Key: 21501970
• Report Number: 1282497-2025-00101
• Device Sequence Number: 7974500
• Product Code: MSD
• UDI-Device Identifier: 10884521014084
• UDI-Public: 10884521014084
• Combination Product (Y/N): N
• Initial Reporter Country: CH
• PMA/510(K) Number: K111372
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2024
• Device Explanted Year: 2025
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,Company Representative,Distributor
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 03/12/2025

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: 8888145001
• Device Catalogue Number: 8888145001
• Device Lot Number: 2318600151
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 02/08/2025
• Supplement Date Received by Manufacturer: 03/03/2025
• Initial Report FDA Received Date: 03/03/2025
• Supplement Report FDA Received Date: 03/12/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 11/29/2023
• 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: 55 YR
• Patient Sex: Male
• Patient Weight: 63 KG