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

Model Number	8888145014P
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
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, in preparation for dialysis, before flushing, a crack, break, and leak were observed in the blue (venous) luer adapter/joint/connector.No instrument was used to loosen or tighten the device.The cleaning agent used on the device was iodophor, and it was the cleaning agent typically utilized to clean the adapters.The cleaning agent was allowed to dry thoroughly prior to applying ointments to the area.A tego was not utilized.The insertion site was not treated prior to product placement.The method utilized to tighten the adapters was by hand.There were no other products being utilized with the device.There were no other defects or damages found on the product.The catheter was repaired by replacing the luer adapter with a domestic temporary luer adapter, and treatment proceeded and was completed.A repair kit was not used.The attending physician was notified.There was no blood loss as a result of the event, and no blood transfusion was required.No medical intervention/treatment was required as a result of the event.There was no reported patient injury.
Event or Problem Description
According to the reporter, in preparation for dialysis, before flushing, a crack, break, and leak were observed in the blue (venous) luer adapter/joint/connector.No instrument was used to loosen or tighten the device.The cleaning agent used on the device was iodophor, and it was the cleaning agent typically utilized to clean the adapters.The cleaning agent was allowed to dry thoroughly prior to applying ointments to the area.A tego was not utilized.The insertion site was not treated prior to product placement.The method utilized to tighten the adapters was by hand.There were no other products being utilized with the device.There were no other defects or damages found on the product.The catheter was repaired by replacing the luer adapter with a domestic temporary catheter's luer adapter, and treatment proceeded and was completed.A repair kit was not used.The attending physician was notified.There was no blood loss as a result of the event, and no blood transfusion was required.No medical intervention/treatment was required as a result of the event.There was no reported patient injury.
Additional Manufacturer Narrative
Additional information: b5, g3.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.

• Brand Name: PALINDROME
• 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: 22322615
• Report Number: 1282497-2025-00438
• Device Sequence Number: 8818633
• Product Code: MSD
• UDI-Device Identifier: 10884521157972
• UDI-Public: 10884521157972
• Combination Product (Y/N): N
• Initial Reporter Country: CH
• PMA/510(K) Number: K123196
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,Company Representative,Distributor
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 06/26/2025

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: 8888145014P
• Device Catalogue Number: 8888145014P
• Device Lot Number: 2329000413
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 06/09/2025
• Supplement Date Received by Manufacturer: 06/26/2025
• Initial Report FDA Received Date: 06/24/2025
• Supplement Report FDA Received Date: 06/26/2025
• Date Device Manufactured: 10/24/2023
• 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 Sex: Unknown