inforMED
InjuryDTL

DEROYAL MANIFOLD 3 PORT RIGHT HAND, OFF HANDLE LOW PRESSURE

Received Aug 20, 2025 · Event occurred Jul 15, 2025

Report 3004605321-2025-00012 · MDR key 22852946

Device

Generic name

Adaptor, Stopcock, Manifold, Fitting, Cardiopulmonary Bypass

Model number

60-3225

Product problems

  • Crack
  • Crack

Patient

NA · Unknown

  • Air Embolism
  • Air Embolism

Narrative

Additional Manufacturer Narrative

A DISTRIBUTING FACILITY REPORTED THROUGH MEDWATCH #1423395-2025-00089, "DEFECTIVE MANIFOLD." FOLLOW UP INFORMATION OBTAINED FROM EMAIL ALSO STATED, "SUSPECTED AIR EMBOLISM INTRODUCED THROUGH DEFECTIVE MANIFOLD." THE CUSTOMER REPORTED THAT THERE WAS A "CRACK ON THE END OF THE MANIFOLD WHERE CONNECTING TUBE CONNECTS TO MANIFOLD GOING TO CATHETER". DEROYAL INDUSTRIES, INC. REQUESTED RETURN OF THE DEVICE, BUT IT WAS NOT AVAILABLE FOR RETURN. BECAUSE THERE WAS ALSO NO LOT NUMBER PROVIDED WITH THE COMPLAINT, THE SPECIFIC DEVICE HISTORY RECORD COULD NOT BE REVIEWED. THE MANUFACTURING AND ASSEMBLY PROCESSES FOR MANIFOLDS AS A WHOLE WERE REVIEWED. SAMPLE UNITS ARE TESTED PRIOR TO ASSEMBLY AND AFTER ASSEMBLY IN INITIAL AND FINAL INSPECTIONS WITH THE FOLLOWING TESTS: VISUAL INSPECTION, TORQUE TEST, VACUUM LEAK TEST, AND HYDROSTATIC TEST. FROM THESE INSPECTIONS NO ISSUES WERE IDENTIFIED. A COMPLAINT TO SALES RATIO WAS CONDUCTED FROM JANUARY 2023 TO SEPTEMBER 2025 AND FOUND TO BE 0.0006%. ROOT CAUSE: BECAUSE THE SAMPLE WAS NOT AVAILABLE FOR RETURN AND NO ISSUES COULD BE FOUND WITHIN THE INVESTIGATION, NO ROOT CAUSE COULD BE DETERMINED. CORRECTIVE AND PREVENTIVE ACTIONS: BECAUSE NO ROOT CAUSE COULD BE DETERMINED, NO CORRECTIVE OR PREVENTIVE ACTIONS WERE TAKEN AT THIS TIME. DEROYAL WILL CONTINUE TO MONITOR FOR TRENDS AROUND THIS ITEM AND ISSUE. THIS INVESTIGATION IS COMPLETE AT THIS TIME. NO FURTHER INFORMATION IS AVAILABLE AT THIS TIME. WE WILL PROVIDE FOLLOW UP REPORT IF ADDITIONAL INFORMATION BECOMES AVAILABLE.

Additional Manufacturer Narrative

A DISTRIBUTING FACILITY REPORTED THROUGH MEDWATCH #1423395-2025-00089, "DEFECTIVE MANIFOLD." FOLLOW UP INFORMATION OBTAINED FROM EMAIL ALSO STATED, "SUSPECTED AIR EMBOLISM INTRODUCED THROUGH DEFECTIVE MANIFOLD." THE CUSTOMER REPORTED THAT THERE WAS A "CRACK ON THE END OF THE MANIFOLD WHERE CONNECTING TUBE CONNECTS TO MANIFOLD GOING TO CATHETER". DEROYAL INDUSTRIES, INC. REQUESTED RETURN OF THE DEVICE, BUT IT WAS NOT AVAILABLE FOR RETURN. THIS INVESTIGATION IS NOT COMPLETE AT THIS TIME. NO FURTHER INFORMATION IS AVAILABLE AT THIS TIME. WE WILL PROVIDE FOLLOW UP REPORT WHEN ADDITIONAL INFORMATION BECOMES AVAILABLE.

Description of Event or Problem

A DISTRIBUTING FACILITY REPORTED THROUGH MEDWATCH #1423395-2025-00089, "DEFECTIVE MANIFOLD." FOLLOW UP INFORMATION OBTAINED FROM EMAIL ALSO STATED, "SUSPECTED AIR EMBOLISM INTRODUCED THROUGH DEFECTIVE MANIFOLD." THE CUSTOMER REPORTED THAT THERE WAS A "CRACK ON THE END OF THE MANIFOLD WHERE CONNECTING TUBE CONNECTS TO MANIFOLD GOING TO CATHETER".