MAUDE Adverse Event Report: C.R. BARD, INC. (COVINGTON) -1018233 MAGIC3¿ INTERMITTENT CATHETER; MAGIC 3 CATHETER

Model Number	53514
Medical Device Problem Code	Patient-Device Incompatibility (2682)
Health Effect - Clinical Codes	Thrombus (2101); Patient Problem/Medical Problem (2688)
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
The investigation is still in progress.Once the investigation is complete a supplemental report will be filed.The information provided by bard represents all of the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bard.The device was not returned.
Event or Problem Description
It was reported that the patient developed a blood clot during use of the catheter and required hospitalization.
Additional Manufacturer Narrative
The reported event was unconfirmed.Visual evaluation noted no obvious defects.All of the catheters felt normal.We were unable to verify the reported event without further testing.An organoleptic test was performed.The lubricious coating material remained on all catheters after more than 10 wipes.All catheters measured to be 14fr.The outer diameters were measured to be 0.180 (0.183 +/-0.013) and length 15.80 (15.83 +/- 0.675), and both were determined to be within specification.The device history record was reviewed and found nothing that could have caused or contributed to the reported event.The instructions for use was found adequate and states the following: "intermittent catheter with sure-grip¿ sleeve hydrophilic coated silicone instructions for use intended use: ¿ the catheter is intended for urinary bladder drainage in patients requiring catheterization for management of incontinence, voiding dysfunction, and surgical procedures.Please contact your physician to determine which product options are best for you, paying close attention to product warnings/ precautions and adverse reactions.¿ wash your hands thoroughly with soap and water.¿ release the sterile water from the foil packet.¿ tip the catheter pouch end-to-end three to six times so the water moves back and forth to thoroughly wet the catheter surface.¿ peel open the pack at the funnel end just enough to expose the insertion sleeve.Don¿t remove the catheter yet.Use the adhesive tab at the funnel end of the pack to stick the pack to a nearby vertical surface while preparing to catheterize.¿ wash the area around the meatus before catheterizing.¿ wash your hands again.Hold the insertion sleeve with your dominant hand and squeeze it to grip the catheter shaft as you remove the catheter from the pack.¿ next, hold the catheter funnel above the insertion sleeve with your other hand and slide the insertion sleeve down the shaft, stopping at about 6¿ from the tip.Release the funnel.¿ using the insertion sleeve to hold the catheter firmly, gently pass the tip of the catheter into your urethra until the insertion sleeve nears the meatus.Repeat until urine starts to flow.¿ try to keep the catheter steady until urine stops flowing.When urine stops flowing, slowly withdraw the catheter, stopping if flow starts again, until the last few drops have drained.¿ finish by disposing of the catheter and its packaging.Wash your hands with soap and water.Warning: ¿ this is a single use device.Do not reuse.Reuse of a single use device increases the risk of catheter acquired urinary tract infections.¿ urethral catheter for urological use only.Discard after use.Made of silicone elastomer." correction: concomitant medical products and device evaluated by mfr.
Event or Problem Description
It was reported that the patient developed a blood clot during use of the catheter and required hospitalization.

• Brand Name: MAGIC3¿ INTERMITTENT CATHETER
• Common Device Name: MAGIC 3 CATHETER
• Manufacturer (Section D): C.R. BARD, INC. (COVINGTON) -1018233; 8195 industrial blvd; covington GA 30014
• MDR Report Key: 7846780
• Report Number: 1018233-2018-03962
• Device Sequence Number: 13738912
• Product Code: MJC
• UDI-Device Identifier: 00801741068515
• UDI-Public: (01)00801741068515
• Combination Product (Y/N): N
• Initial Reporter State: OH
• Initial Reporter Country: US
• PMA/510(K) Number: K033477
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: consumer,other
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 12/10/2018

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: Lay User/Patient
• Device Expiration Date: 02/28/2023
• Device Model Number: 53514
• Device Catalogue Number: 53514
• Device Lot Number: JUCQ0233
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 09/24/2018
• Initial Date Received by Manufacturer: 08/13/2018
• Supplement Date Received by Manufacturer: 11/19/2018
• Initial Report FDA Received Date: 09/05/2018
• Supplement Report FDA Received Date: 12/10/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Hospitalization