MAUDE Adverse Event Report: ACCESS VASCULAR, INC. HYDROMID; INTRAVASCULAR CATHETER

Model Number	MID-141CM
Medical Device Problem Codes	Fluid/Blood Leak (1250); Insufficient Device Problem Information (3190)
Health Effect - Clinical Code	Thrombosis/Thrombus (4440)
Date of Event	06/23/2025
Type of Reportable Event	Serious Injury
Event or Problem Description
Nurse reported that patient with catheter placed had elbow swelling.There was no pain or leaking at the site.Ultrasound diagnosed deep vein thrombosis.It is unknown if any intervention was required.Patient condiiton is also unknown.

• Brand Name: HYDROMID
• Common Device Name: INTRAVASCULAR CATHETER
• Manufacturer (Section D): ACCESS VASCULAR, INC.; 749 middlesex turnpike; billerica MA 01821
• Manufacturer (Section G): ACCESS VASCULAR, INC.; 749 middlesex turnpike; billerica MA 01821
• Manufacturer Contact: scott blood ; 749 middlesex turnpike; billerica, MA 01821 ; 7815386594
• MDR Report Key: 25566584
• Report Number: 3021570645-2026-00009
• Device Sequence Number: 9995108
• Product Code: FOZ
• UDI-Device Identifier: 00850030354365
• UDI-Public: 00850030354365
• Combination Product (Y/N): N
• Initial Reporter State: MT
• Initial Reporter Country: US
• PMA/510(K) Number: K220772
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2025
• Device Explanted Year: 2025
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional,User Facility
• Initial Reporter Occupation: Nurse
• Type of Report: Initial
• Report Date (Section B): 06/19/2026

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Health Professional
• Device Expiration Date: 10/01/2026
• Device Model Number: MID-141CM
• Device Catalogue Number: FG-80H04104
• Device Lot Number: 02122503
• 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: 05/21/2026
• Initial Report FDA Received Date: 06/19/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 10/19/2024
• 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 Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: ANTIBIOTIC DAPTOMYCINANTIBIOTIC CEFTRIAXONE
• Outcome Attributed to Adverse Event: Other
• Patient Sex: Unknown