MAUDE Adverse Event Report: COOK INC MIXTER ENDOSCOPIC CHOLANGIOGRAPHY SET; GBZ CATHETER, CHOLANGIOGRAPHY

Model Number	N/A
Medical Device Problem Code	Device Contamination with Chemical or Other Material (2944)
Health Effect - Clinical Code	No Patient Involvement (2645)
Date of Event	09/28/2017
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(6).(b)(4).The event is currently under investigation.A follow-up report will be submitted upon receipt of additional information or completion of the investigation.
Event or Problem Description
The international customer reported that, during an pre-use inspection of the mixter endoscopic cholangiography set, an unidentified hair was discovered in the primary package.The customer confirmed that the device never made contact with any patient; accordingly, no adverse events occurred.The product is reportedly unavailable for return.
Additional Manufacturer Narrative
Investigation summary: a review of the complaint history, device history record, specifications, quality control data and a photo inspection were conducted during the investigation.The device was not returned for evaluation.However, the customer provided images of the defect which confirm an unidentified black particle inside of a primary package.Additionally, a document based investigation evaluation was performed.The device history record was reviewed and 1 non-conformance was noted; however, all nonconforming product was scrapped prior to further processing.It should be noted there were no other reported complaints for this lot number.Based on the information provided and the results of our investigation, the foreign matter found inside the sealed package, has been attributed to the manufacturing/packaging process.Per the quality engineering risk assessment, no further action is required.Appropriate personnel have been notified and monitoring will continue to be performed for similar complaints.

• Brand Name: MIXTER ENDOSCOPIC CHOLANGIOGRAPHY SET
• Common Device Name: GBZ CATHETER, CHOLANGIOGRAPHY
• Manufacturer (Section D): COOK INC; 750 daniels way; bloomington IN 47404
• MDR Report Key: 6944103
• Report Number: 1820334-2017-03486
• Device Sequence Number: 16314555
• Product Code: GBZ
• UDI-Device Identifier: 00827002080454
• UDI-Public: (01)00827002080454(17)200505(10)7888941
• Combination Product (Y/N): N
• Initial Reporter Country: BR
• 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): 01/29/2018

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 Model Number: N/A
• Device Catalogue Number: C-OECS-400-MIXTER
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 09/28/2017
• Supplement Date Received by Manufacturer: 01/12/2018
• Initial Report FDA Received Date: 10/12/2017
• Supplement Report FDA Received Date: 01/29/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1