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Adverse Event Report

ALLEGIANCE HEALTHCARE OB PACK   back to search results
Model Number SMA12OBFHB
Event Date 10/20/1997
Event Type  Malfunction   Patient Outcome  Required Intervention;
Manufacturer Narrative

The cord clamp is a component of this pack, which we purchase bulk non-sterile. The mfr of the clamp has been notified and asked to investigate. Qfc part number: qfc-650. Qfc lot number: 163-97. Qfc responses rec'd on 10-24-97 and 10-27-97 indicate: testing of samples from lot in question were rec'd and regular product testing was performed. It was confirmed that when the clamp is closed tightly enough to engage the locking mechanism the clamp does remain in a closed position. Production and inspection records in qc files were reviewed and revealed acceptance by production and inspection. Qfc has taken the following corrective actions: 1. Teeth are being adjusted to give complete closure when clamp is in closed position. 2. Outside teeth radius is being reduced to give an improved gripping effect. 3. Finish of teeth area is being changed from a polished finish to an edm finish, to improve gripping.

 
Event Description

The infant was less than 3 hrs old. The surgeon had clamped and cut the umbilical cord the infant was then passed to the mother to see her infant. The nurse took the infant approx 4 feet to the infant warmer for add'l cleaning and routine. The rn turned to complete the infants chart and upon returning to the infant noticed bleeding through the infants wrap. Upon examination it was noticed that the cord clamp had opened partially and fell off. A kelly clamp was placed on the umbilical cord until another cord clamp was obtained and placed on the infant. No add'l med treatment was done.

 
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Brand NameOB PACK
Type of DeviceOB PACK
Baseline Brand NameOB PACK
Baseline Generic NameOB PACK
Baseline Catalogue NumberSMA12OBFHB
Baseline Model NumberSMA12OBFHB
Baseline Device 510(K) Number
Baseline Device PMA Number
Manufacturer (Section F)
ALLEGIANCE HEALTHCARE
1500 waukegan rd.
mcgaw park IL 60085
Manufacturer (Section D)
ALLEGIANCE HEALTHCARE
1500 waukegan rd.
mcgaw park IL 60085
Manufacturer (Section G)
CARDINAL HEALTH-MEDICAL PRODUCTS AND SERVICES
1430 waukegan rd.
mcgaw park IL 60085
Device Event Key127794
MDR Report Key130674
Event Key122875
Report Number1423537-1997-00230
Device Sequence Number1
Product CodeMLS
Report Source Manufacturer
Source Type Health Professional
Reporter Occupation Other
Type of Report Initial
Report Date 11/07/1997
1 Device Was Involved in the Event
1 Patient Was Involved in the Event
Date FDA Received11/07/1997
Is This An Adverse Event Report? No
Is This A Product Problem Report? Yes
Device Operator Health Professional
Device MODEL NumberSMA12OBFHB
Device Catalogue NumberSMA12OBFHB
Device LOT Number279226
Was Device Available For Evaluation? No
Is The Reporter A Health Professional? Yes
Was the Report Sent to FDA? No
Event Location Hospital
Date Manufacturer Received10/21/1997
Was Device Evaluated By Manufacturer? Yes
Is The Device Single Use? Yes
Is the Device an Implant? No
Is this an Explanted Device?
Type of Device Usage Initial

Database last updated on December 31, 2008

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