MAUDE Adverse Event Report: TOGO MEDIKIT CO. LTD. SUPERCATH 5; CATHETER, INTRAVASCULAR, THERAPEUTIC, SHORT-TERM LESS THAN 30 DAYS

Catalog Number SP206-01

Device Problems Fracture (1260); Material Separation (1562)

Patient Problem Foreign Body In Patient (2687)

Event Date 01/07/2020

Event Type  Injury  

Manufacturer Narrative

The device involved in the event was not returned.The repeatability test (tensile strength testing etc.) was conducted using reserved samples with the lot numbers listed below that had the possibility to be the same lot number as that involved in the event.Also, the investigation was conducted by reviewing the records of manufacturing processes of the iv catheter with the lot numbers listed below, and it was confirmed that there were no manufacturing processes that caused or contributed to the event, and there were no manufacturing records of visual inspections that showed the cause of or contribution to the event.Judging from this examination, a possible cause of this fracture is that a patient himself/herself has pulled the device with a force greater than acceptable level.In result, catheter could not endure the tensile strength, then it was broken.Lot#: 19j17s3.

Event Description

On (b)(6) 2020, at a hospital in (b)(6), it was reported that supercath5 safety i.V.Catheter was found to be fractured by the confirmation of the device by a nurse because of a removal of the catheter from a patient's body by the patient during an infusion.There was a possibility that the fractured portion fell off when a fixing tape was peeled off, since the presence of the fractured portion was not confirmed in the patient's body.There was no reported patient injury as a result of this event.

• Brand Name: SUPERCATH 5
• Type of Device: CATHETER, INTRAVASCULAR, THERAPEUTIC, SHORT-TERM LESS THAN 30 DAYS
• Manufacturer (Section D): TOGO MEDIKIT CO. LTD.; 17148-6 aza kamekawa; oaza hichiya; hyuga city, 883-0 062; JA 883-0062
• Manufacturer (Section G): TOGO MEDIKIT CO. LTD.; 17148-6 aza kamekawa; oaza hichiya; hyuga city, 883-0 062; JA 883-0062
• Manufacturer Contact: yashaswini patwardhan ; amselweg 5; rheda-wiedenbrueck, 33378 ; GM 33378
• MDR Report Key: 9693133
• MDR Text Key: 189193673
• Report Number: 9612126-2020-00002
• Device Sequence Number: 1
• Product Code: FOZ
• Combination Product (y/n): N
• Reporter Country Code: JA
• PMA/PMN Number: K140419
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: distributor,foreign
• Reporter Occupation: Nurse
• Type of Report: Initial
• Report Date: 02/11/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 02/11/2020
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Catalogue Number: SP206-01
• Device Lot Number: 19J17S3
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: Yes
• Date Manufacturer Received: 01/14/2020
• Was Device Evaluated by Manufacturer?: Yes
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention