BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    COMBINATION SET 102', ANTI-SIPHON

    MDR report key: 1241608 · Received November 25, 2008

    Report

    Report Number
    6000001-2007-02116
    Event Type
    Malfunction
    Date Received
    November 25, 2008
    Date of Event
    January 15, 2007
    Report Date
    January 17, 2007
    Manufacturer
    BAXTER HEALTHCARE CORPORATION
    Product Code
    FPA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    A REQUEST FOR THE RETURN OF THE DEVICE HAS BEEN MADE, SHOULD THE REPORTED DEVICE BE RETURNED AND EVALUATED A FOLLOW UP REPORT WILL BE SUBMITTED.

    Description of Event or Problem · 1

    COMPLAINT RECEIVED FROM BAXTER SALES REP. CUSTOMER REPORTS THAT LEAKAGE WAS DETECTED COMING FROM THE CONNECTION NEAR THE INJECTION SITE WHEN USING A BD SYRINGE TO DELIVER MORPHINE. THERE WAS NO REPORTED PATIENT INJURY OR MEDICAL INTERVENTION. NO ADDITIONAL INFORMATION IS AVAILABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 COMBINATION SET 102', ANTI-SIPHON ANESTHESIA EXTENSION SET FPA BAXTER HEALTHCARE CORPORATION NA NA01

    Patients

    Seq Age Sex Outcome Treatment
    1