BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CODAN TRIFURCATED EXTENSION SET

    MDR report key: 10791992 · Received November 5, 2020

    Report

    Report Number
    10791992
    Event Type
    Malfunction
    Date Received
    November 5, 2020
    Date of Event
    October 4, 2020
    Report Date
    October 20, 2020
    Manufacturer
    CODAN US CORPORATION
    Product Code
    FPA
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    MN
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    ATTEMPTED TO DISCONNECT TRIFUSER FROM CVC TO UNTANGLE TUBES/LINES AND THE TRIFUSER CRUMBLED UPON TURNING AND THE END OF THE TRIFUSER WAS LEFT IN THE MICROCLAVE. THE WHOLE END THEN BROKE OFF.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1260545 CODAN TRIFURCATED EXTENSION SET SET, ADMINISTRATION, INTRAVASCULAR FPA CODAN US CORPORATION

    Patients

    Seq Age Sex Outcome Treatment
    1