BEUDAMED
    FDA Adverse Event Other Summary report: N

    BD INTERLINK

    MDR report key: 1062316 · Received June 17, 2008

    Report

    Report Number
    2618282-2008-00012
    Event Type
    Other
    Date Received
    June 17, 2008
    Report Date
    May 27, 2008
    Manufacturer
    BECTON DICKINSON INFUSION THERAPY SYSTEMS
    Product Code
    FOZ
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    ADDITIONAL INFORMATION HAS BEEN REQUESTED. UPON COMPLETION OF THE INVESTIGATION, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

    Description of Event or Problem · 1

    THE EXTENSION SET BECAME DISCONNECTED FROM THREADED LOCK CANNULA. THE DISCONNECTION OCCURRED AT END OF EXTENSION SET WHERE SLIDING COLLAR IS LOCATED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BD INTERLINK THREADED LOCK CANNULA FOZ BECTON DICKINSON INFUSION THERAPY SYSTEMS NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK Other