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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ETHICON INC. BLAKE; CATHETER, IRRIGATION

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ETHICON INC. BLAKE; CATHETER, IRRIGATION Back to Search Results
Catalog Number 2233
Medical Device Problem Code Material Integrity Problem (2978)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
Product complaint # (b)(4).Additional information has been requested and received.Attempts to obtain the device have been made.If further details are received at a later date a supplemental medwatch will be sent."was the new drain placed surgically during a second procedure? =>unk - could you kindly perform and document the follow-up attempt for the product return =>the device will be shipped.- please provide the source or name of person providing answers to follow-up questions:=>(b)(6).H3 evaluation: complaint sample review: one complaint sample of drain with trocar was received for evaluation, product was inspected visually 1.Sticking mark was found on the trocar (visual inspection attached for reference).2.However, chip-off marks on upper surface of the drain were visible, while inspected under magnification.As per standard practice, 100% functional test and 100% visual inspection was carried out, before and after packing of finished goods, prior to the product release.There was no scope to miss such defect, at manufacturing / release stage.Documents review : during investigation of complaint, batch review of in-process and final packaging inspections, as well as the manufacturing process is performed, these products are reported to be manufactured, inspected, and packaged in conformance with customer's specifications and have been found to be acceptable within all parameters.No discrepancy as per the reported defect is observed.Retention sample review : no negative observation was found.Review of defective sample's image / video : not applicable, as there was no complaint sample image / video received for evaluation.The device history records were reviewed and the manufacturing criteria was met prior to the release of this lot.This report is being submitted pursuant to the provisions of 21 cfr, part 803.This report may be based on information which has not been investigated or verified prior to the required reporting date.This report does not reflect a conclusion by ethicon, or its employees that the report constitutes an admission that the product, ethicon, or its employees caused or contributed to the potential event described in this report.If information is obtained that was not available for the initial report, a follow-up report will be filed as appropriate.
 
Event or Problem Description
It was reported a patient underwent an unknown surgery on an unknown date and a drain was used.The drain had been adhered to the bendable trocar needle, and when they were separated, a foreign matter remained inside the drain lumen.The product was not used for the patient, so there were no adverse consequences to the patient.Another product was used to complete the case.Further details are not provided.Upon receipt and analysis, sticking mark was found and chip marks.
 
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Brand Name
BLAKE
Common Device Name
CATHETER, IRRIGATION
Manufacturer (Section D)
ETHICON INC.
1000 route 202
raritan NJ 08869
Manufacturer (Section G)
DEGANIA INDIA
251, sector-6, imt manesar
gurugram 12205 2
IN   122052
Manufacturer Contact
orla o'mahony
1000 route 202
raritan, NJ 08869
3035526892
MDR Report Key25435868
Report Number2210968-2026-06121
Device Sequence Number13333285
Product Code GBX
UDI-Device Identifier10705031003613
UDI-Public(01)10705031003613(17)291228(10)J2403056
Combination Product (Y/N)N
Initial Reporter CountryJA
PMA/510(K) Number
EXEMPT
Number of Events Summarized1
Summary Report (Y/N)N
Serviced by Third Party (Y/N)Unknown
Reporter Type Manufacturer
Report Source Foreign,Company Representative
Initial Reporter Occupation Other
Type of Report Initial
Report Date (Section B) 06/08/2026
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 Number2233
Device Lot NumberJ2403056
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer03/10/2026
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 05/26/2026
Initial Report FDA Received Date06/08/2026
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured12/28/2024
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 Number1
Patient SexUnknown
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