BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SPLIT SEPTUM MICRO T-CONNECTOR

    MDR report key: 10919285 · Received November 30, 2020

    Report

    Report Number
    10919285
    Event Type
    Malfunction
    Date Received
    November 30, 2020
    Date of Event
    November 15, 2020
    Report Date
    November 19, 2020
    Manufacturer
    HUMMINGBIRD MED DEVICES INC
    Product Code
    FPA
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CA
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    THE HUMMI CRACKED AND LEAKED AT THE JUNCTION OF THE FLEXIBLE TUBING AND HARD PLASTIC.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1383638 SPLIT SEPTUM MICRO T-CONNECTOR SET, ADMINISTRATION, INTRAVASCULAR FPA HUMMINGBIRD MED DEVICES INC NMT8046 19293

    Patients

    Seq Age Sex Outcome Treatment
    1 90 DA