inforMED
MalfunctionMPO

NOVAPLUS INFANT HEEL WARMER SQUEEZE

Received May 27, 2023 · Event occurred May 4, 2023

Report 1423537-2023-00941 · MDR key 17015412

Device

Generic name

Infant Heel Warmer (chemical Heat Pack)

Manufacturer

Mo016 Mo-moberly

Model number

V11460-010

Catalog number

V11460-010

Lot number

V2S056

Product problems

  • Burst Container or Vessel
  • Burst Container or Vessel

Patient

Unknown

  • No Clinical Signs, Symptoms or Conditions
  • No Clinical Signs, Symptoms or Conditions

Narrative

Additional Manufacturer Narrative

THE ACTUAL COMPLAINT SAMPLE WAS DISCARDED BY THE CUSTOMER; THEREFORE, A ROOT CAUSE COULD NOT BE DETERMINED. A REVIEW OF THE DEVICE HISTORY RECORD WAS COMPLETED ON THE REPORTED LOT NUMBER, V2S056. THE LOT WAS FOUND TO HAVE BEEN MANUFACTURED AND RELEASED TO PREDETERMINED SPECIFICATIONS AND NO ANOMALIES WERE FOUND DURING REVIEW OF THE RECORDS. CARDINAL HEALTH WILL CONTINUE TO MONITOR COMPLAINT TRENDS FOR THIS REPORTED ISSUE.

Description of Event or Problem

CUSTOMER REPORTED THE NOVA PLUS HEEL WARMER BURST THROUGH THE PACKAGING WHEN ACTIVATED. THE LIQUID GEL DEBRIS FROM HEEL WARMER PACK SPLATTERED ON STAFF MEMBER. THE DEBRIS WAS WIPED OFF THE STAFF MEMBER AND THE HEAL WARMER WAS DISCARDED. NO INJURY REPORTED.