BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    DUAL DRAINAGE VENOUS RETURN CANNULA

    MDR report key: 110694 · Received August 1, 1997

    Report

    Report Number
    1713910-1997-00027
    Event Type
    Malfunction
    Date Received
    August 1, 1997
    Date of Event
    June 14, 1997
    Report Date
    July 31, 1997
    Manufacturer
    RESEARCH MEDICAL, INC.
    Product Code
    DWF
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AS
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    DURING USE OF A VENOUS RETURN CANNULA A SPLIT/CRACK WAS NOTED IN THE CANNULA. THE CANNULA WAS REPLACED WITH NO ADVERSE AFFECT TO THE PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DUAL DRAINAGE VENOUS RETURN CANNULA VENOUS RETURN CANNULA DWF RESEARCH MEDICAL, INC. NA 89938

    Patients

    Seq Age Sex Outcome Treatment
    1 * Other