MAUDE Adverse Event Report: ICU MEDICAL MANUFACTURING S.A. DE C.V. BIVONA NEONATAL AND PEDIATRIC TTS TRACHEOSTOMY TUBE; TUBE TRACHEOSTOMY AND TUBE CUFF

Catalog Number	67PFS40
Medical Device Problem Codes	Material Puncture/Hole (1504); Gas/Air Leak (2946)
Health Effect - Clinical Code	Insufficient Information (4580)
Date of Event	10/13/2025
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Investigation including root cause analysis is in progress.A supplemental mdr will be filed as necessary in accordance with 21 cfr 803.56 when additional information becomes available.
Event or Problem Description
It was reported that the cuff was not fully deflated, only one side was inflated, and the patient was harmed due to air leakage around the trachea.Per reporter, the pediatric patient's outcome was still ongoing.
Additional Manufacturer Narrative
H3: one photo and video were attached to the complaint.Review of the photo was performed, and a portion of the cuff was seen to be stuck to the tube.Review of the attached video found that the recommended trouble shooting procedures where according to the instructions for use (ifu0000843 ifu, a test where a syringe is attached to the pilot balloon and slowly inflating the cuff with 5 ml of sterile water was not performed.In addition to the test, squeezing the pilot balloon while manipulating the cuff from the shaft was also not performed as well.The customers' issue was confirmed; however, a physical sample is necessary in order to perform a complete evaluation.The root cause of the issue was unknown.A retrospective review of 12-month period (nov 2024 to nov 2025) was made for complaints originated related to this issue and no additional complaints were identified to this part number 67pfs40 and lot.

• Brand Name: BIVONA NEONATAL AND PEDIATRIC TTS TRACHEOSTOMY TUBE
• Common Device Name: TUBE TRACHEOSTOMY AND TUBE CUFF
• Manufacturer (Section D): ICU MEDICAL MANUFACTURING S.A. DE C.V.; ave calidad no. 4, parque; tijuana ; MX
• Manufacturer Contact: reed covert ; 6000 nathan lane north; minneapolis, MN 55442 ; 2247062300
• MDR Report Key: 23457619
• Report Number: 3012307300-2025-12008
• Device Sequence Number: 12780776
• Product Code: JOH
• UDI-Device Identifier: 10351688518620
• UDI-Public: (01)10351688518620(17)260304(10)4119124
• Combination Product (Y/N): N
• Initial Reporter Country: KU
• PMA/510(K) Number: K923878
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,User Facility
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 12/11/2025

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 Expiration Date: 03/04/2026
• Device Catalogue Number: 67PFS40
• Device Lot Number: 4119124
• 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: 10/13/2025
• Supplement Date Received by Manufacturer: 11/28/2025
• Initial Report FDA Received Date: 11/03/2025
• Supplement Report FDA Received Date: 12/11/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 04/05/2021
• 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