BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PHASEAL INFUSION ADAPTER

    MDR report key: 1243608 · Received November 24, 2008

    Report

    Report Number
    1243608
    Event Type
    Malfunction
    Date Received
    November 24, 2008
    Date of Event
    November 13, 2008
    Report Date
    November 21, 2008
    Manufacturer
    CARMEL PHARMA
    Product Code
    FPA
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    IV TUBING SNAPPED OFF OF SPIKE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PHASEAL INFUSION ADAPTER PHASEAL INFUSION ADAPTER FPA CARMEL PHARMA 8320394

    Patients

    Seq Age Sex Outcome Treatment
    1 60 YR