MAUDE Adverse Event Report: ARROW INTERNATIONAL LLC ARROW CVC SET: 3-LUMEN 4FR X 13CM; CATHETER, PERCUTANEOUS

Catalog Number	CS-14403
Medical Device Problem Code	Material Separation (1562)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/21/2026
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that "when the guide wire was inserted, it wouldn't go through, and when the guide wire was removed, it broke and opened up, leaving pieces of the wire in the catheter.It was first tried with the cs-14402 and then with the cs-14403, having the same issue with both cvc".Another wire was used to complete the procedure.There was a delay to therapy.There was no patient complications or injury.The patient's current condition is reported as "critical".Associate mdr numbers include: 9680794-2026-00301.
Additional Manufacturer Narrative
(b)(4).

• Brand Name: ARROW CVC SET: 3-LUMEN 4FR X 13CM
• Common Device Name: CATHETER, PERCUTANEOUS
• Manufacturer (Section D): ARROW INTERNATIONAL LLC; morrisville NC
• Manufacturer (Section G): ARROW INTERNATIONAL CR, A.S.; jamska 2359/47; zdar nad sazavou 591 0 1; EZ 591 01
• Manufacturer Contact: katharine tarpley ; 3015 carrington mill blvd; morrisville, NC 27560
• MDR Report Key: 24887378
• Report Number: 3006425876-2026-00433
• Device Sequence Number: 18597779
• Product Code: DQY
• UDI-Device Identifier: 00801902000415
• UDI-Public: (01)00801902000415(11)231010(17)270630(10)71F23J1374(21)
• Combination Product (Y/N): N
• Initial Reporter Country: EC
• PMA/510(K) Number: K862056
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,User Facility
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 03/27/2026

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 Catalogue Number: CS-14403
• Device Lot Number: 71F23J1374
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 03/27/2026
• Supplement Date Received by Manufacturer: 05/15/2026
• Initial Report FDA Received Date: 04/15/2026
• Supplement Report FDA Received Date: 05/21/2026
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 10/10/2023
• 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
• Concomitant Medical Products and Therapy/Usage Dates: NOT REPORTED
• Patient Age: 6 MO
• Patient Sex: Unknown
• Patient Weight: 3 KG