MAUDE Adverse Event Report: COOK INC TRIPLE LUMEN POLYURETHANE CENTRAL VENOUS CATHETER SET; DQY CATHETER, PERCUTANEOUS

Model Number N/A

Device Problem Tear, Rip or Hole in Device Packaging (2385)

Patient Problem No Patient Involvement (2645)

Event Date 06/18/2019

Event Type  malfunction  

Manufacturer Narrative

Occupation: unknown.Pma/510(k) #: not exempt, pre-amendment.This report includes information known at this time.A follow-up report will be submitted should additional relevant information become available.

Event Description

It was reported that during the distributor's packaging inspection of a cook triple lumen polyurethane central venous catheter set, a small hole was detected in the back of the package.It was also noted that the primary package was damaged.

Event Description

No additional information regarding the patient and/or event has been received since the previous medwatch report was sent.

Manufacturer Narrative

Blank fields on this form indicate the information is unknown, unavailable, or unchanged.Investigation - evaluation.A review of the documentation including the complaint history, device history record, instructions for use (ifu) and quality control, as well as a visual examination of photos of the complaint device was conducted during the investigation.The complaint device was not returned; therefore, a physical examination could not be performed.However, photos of the device were provided.The complaint was able to be confirmed based on customer testimony and examination of the supplied photos.A pinhole in the packaging was confirmed on the left-hand seal of the tray.The device was unopened, and no other damage was noted.At this time, there is no evidence to confirm that the device was manufactured or packaged out of specification.Additionally, a document-based investigation evaluation was performed.It was concluded that sufficient inspection activities are in place to identify this failure mode prior to distribution.The risk specification document for the product states that adequate risk mitigation activities are in place to capture potential failure modes prior to customer release.A review of the device history record for lot 9316343 shows no non-conformances that could have contributed to the failure mode.Additionally, a database search for complaints on the reported lot found no other complaints reported from the field.From this information, there is no evidence suggesting that there is nonconforming product from this lot in house or in field.The instructions for use (ifu), provides the following information to the user related to the reported failure mode: how supplied: ¿supplied sterilized by ethylene oxide gas in peel-open packages.Intended for one-time use.Sterile if package is unopened or undamaged.Do not use the product if there is doubt as to whether the product is sterile.Store in a dark, dry, cool place.Avoid extended exposure to light.Upon removal from package, inspect the product to ensure no damage has occurred.¿ based on the information provided, no product returned and the results of our investigation, a definitive root cause could be traced to transport/storage.Cook will continue to monitor for similar complaints.Per the quality engineering risk assessment no further action is required.The appropriate personnel have been notified.This report is required by the fda under 21 cfr part 803 and is based on unconfirmed information submitted by others.Neither the submission of this report nor any statement contained herein is intended to be an admission that any cook device is defective or malfunctioned, that a death or serious injury occurred, nor that any cook device caused, contributed to, or is likely to cause or contribute to a death or serious injury if a malfunction occurred.

• Brand Name: TRIPLE LUMEN POLYURETHANE CENTRAL VENOUS CATHETER SET
• Type of Device: DQY CATHETER, PERCUTANEOUS
• Manufacturer (Section D): COOK INC; 750 daniels way; bloomington IN 47404
• MDR Report Key: 8794204
• MDR Text Key: 151161442
• Report Number: 1820334-2019-01699
• Device Sequence Number: 1
• Product Code: DQY
• UDI-Device Identifier: 00827002029378
• UDI-Public: (01)00827002029378(17)211116(10)9316343
• Combination Product (y/n): N
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: distributor,foreign,other
• Type of Report: Initial,Followup
• Report Date: 09/17/2019

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 07/16/2019
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: No Information
• Device Expiration Date: 11/16/2021
• Device Model Number: N/A
• Device Catalogue Number: C-UTLM-701J
• Device Lot Number: 9316343
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 09/16/2019
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1