inforMED
MalfunctionEZS

DUOLOCK TAIL CLSR CURVED TAN

Received Mar 25, 2016

Report 1000317571-2016-00031 · MDR key 5527245

Device

Generic name

Appliance, Colostomy, Disposable

Manufacturer

Convatec Limited

Model number

SRA8280

Lot number

5E03205

Product problems

  • Adverse Event Without Identified Device or Use Problem
  • Adverse Event Without Identified Device or Use Problem

Patient

Not reported

  • Skin Irritation
  • Discomfort
  • Skin Irritation
  • Discomfort

Narrative

Additional Manufacturer Narrative

EXPIRATION DATE: 05/2020. MANUFACTURING DATE: 05/2015. BASED ON THE AVAILABLE INFORMATION, THIS EVENT IS DEEMED A REPORTABLE MALFUNCTION. THERE WERE NO REPORTS OF THE PATIENT BEING HARMED AS A RESULT OF THIS MALFUNCTION. NO FURTHER INFORMATION WAS AVAILABLE AT THE TIME OF THE REPORT. SHOULD ADDITIONAL INFORMATION BECOME AVAILABLE, A FOLLOW-UP REPORT WILL BE SUBMITTED. NOTE: TWO CASES ASSOCIATED WITH THIS COMPLAINT. A SEPARATE FDA FORM 3500A HAS BEEN COMPLETED FOR THE UNKNOWN NUMBER OF AFFECTED PRODUCTS WITH MULTIPLE POSSIBLE LOTS NUMBERS ASSOCIATED WITH THIS COMPLAINT. (B)(4).

Description of Event or Problem

IT WAS REPORTED BY THE END USER THAT THE TAIL CLIPS DIG AND IRRITATE HER FLESH IN THE AREA OF THE ABDOMEN WHERE THE CLIP RESTS/DIGS IN. IT WAS ALSO REPORTED THAT THIS HAS OCCURRED WITH OTHER SIMILAR PRODUCTS FOR YEARS.