BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BLD Y-TYPE 105 OL NV

    MDR report key: 1621177 · Received March 1, 2010

    Report

    Report Number
    9615050-2010-00026
    Event Type
    Malfunction
    Date Received
    March 1, 2010
    Date of Event
    January 1, 2010
    Report Date
    February 2, 2010
    Manufacturer
    HOSPIRA COSTA RICA LTD.
    Product Code
    KDC
    PMA / PMN Number
    K780880
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THE CUSTOMER INDICATED THE DEVICE WAS DISCARDED. THIS REPORT REPRESENTS ALL THE INFO KNOWN BY THE REPORTER UPON QUERY BY HOSPIRA PERSONNEL; (B) (4).

    Description of Event or Problem · 1

    THE CUSTOMER CONTACT REPORTED NO FLOW. THE TUBING SET WAS BEING USED TO DELIVER UNSPECIFIED BLOOD PRODUCTS. IT WAS REPORTED THAT AFTER THE TUBING SET WAS PRIMED, THE CAIR CLAMP WAS PLACED IN THE CLOSED POSITION TO STOP FLOW. AFTER AN UNSPECIFIED LENGTH OF TIME, AFTER THE CLAMP WAS OPENED, THE BLOOD PRODUCTS REPORTEDLY WOULD NOT FLOW. REPORTEDLY A KINK FORMED IN THE TUBING WHERE THE CAIR CLAMP HAD BEEN CLOSED. THE NURSE MANIPULATED THE KINKED TUBING SECTION TO RESUME FLOW. THERE WERE NO REPORTED ADVERSE PT EFFECTS. NO MEDICAL INTERVENTIONS WERE REQUIRED. THOUGH REQUESTED, NO ADDITIONAL INFO WAS PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BLD Y-TYPE 105 OL NV 79KDC KDC HOSPIRA COSTA RICA LTD. NA UNK5H

    Patients

    Seq Age Sex Outcome Treatment
    1