MAUDE Adverse Event Report: COVIDIEN TELFA; DRESSING,WOUND,OCCLUSIVE

Model Number 12388

Device Problem Material Fragmentation (1261)

Patient Problem No Known Impact Or Consequence To Patient (2692)

Event Date 08/04/2017

Event Type  malfunction  

Manufacturer Narrative

Submit date: 9/8/17.An investigation is currently under way; upon completion the results will be forwarded.

Event Description

The customer states that the telfa dressing practically crumbled when ointment was placed on the dressing by the surgeon.

Manufacturer Narrative

There were no samples received with this complaint therefore an examination of the reported condition could not be made.A review of the device history record (dhr) was not performed during this investigation as the lot number was not provided within the complaint.All device history records are reviewed and approved by quality prior to release of product.Because there was no lot number, a date of manufacture could not be determined.Since this complaint will be considered unconfirmed, no corrective or preventive actions will be taken at this time.If additional information or samples are received, the investigation will resume as needed.This complaint will be used for trending purposes.If information is provided in the future, a supplemental report will be issued.

• Brand Name: TELFA
• Type of Device: DRESSING,WOUND,OCCLUSIVE
• Manufacturer (Section D): COVIDIEN; 1647 perkins rd; augusta GA 30913
• Manufacturer (Section G): COVIDIEN; 1647 perkins rd; augusta GA 30913
• Manufacturer Contact: edward almeida ; 15 hampshire street; mansfield, MA 02048 ; 5084524151
• MDR Report Key: 6853625
• MDR Text Key: 85578113
• Report Number: 1018120-2017-05092
• Device Sequence Number: 1
• Product Code: NAD
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: distributor
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 02/26/2018

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 09/08/2017
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: 12388
• Device Catalogue Number: 12388
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 08/14/2017
• Was Device Evaluated by Manufacturer?: No
• Is the Device Single Use?: Yes
• Type of Device Usage: Unknown
• Patient Sequence Number: 1