BEUDAMED
    FDA Adverse Event Other Summary report: N

    PORTEX

    MDR report key: 1067792 · Received June 30, 2008

    Report

    Report Number
    MW5007477
    Event Type
    Other
    Date Received
    June 30, 2008
    Date of Event
    June 26, 2008
    Report Date
    June 30, 2008
    Manufacturer
    SMITHS MEDICAL ASD, INC.
    Product Code
    CBT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    BACK END OF SYRINGE BROKE OFF PRIOR TO USE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PORTEX ARTERIAL BLOOD SAMPLE SYRINGE W/DRY LITHIUM CBT SMITHS MEDICAL ASD, INC. 4041 1284615

    Patients

    Seq Age Sex Outcome Treatment
    1 13 DA Other