FDA Adverse Event Other Summary report: N

CURLIN ADMINISTRATION SET

MDR report key: 1714367 · Received June 2, 2010

Report

Report Number
1722139-2010-00066
Event Type
Other
Date Received
June 2, 2010
Date of Event
April 27, 2010
Report Date
April 28, 2010
Manufacturer
MOOG MEDICAL DEVICES GROUP
Product Code
FRN
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
NJ, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

THE DEVICE WAS NOT RETURNED FOR EVALUATION. NO LOT INFORMATION WAS AVAILABLE. THE RETURNED PRODUCT HAS NOT BEEN RECEIVED FOR INVESTIGATION. IF THE PRODUCT IS RECEIVED, A FOLLOW UP REPORT WILL BE SUBMITTED. NO CLINICAL INJURY TO PT.

Description of Event or Problem · 1

AS REPORTED: TWO SLITS FOUND IN THE ADMIN SET UPON START OF INFUSION. STARTED TO LEAK. NO INJURY OCCURRED AS A RESULT OF THIS COMPLAINT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 CURLIN ADMINISTRATION SET FRN MOOG MEDICAL DEVICES GROUP 340-4168 UNKNOWN

Patients

Seq Age Sex Outcome Treatment
1