BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DUAL STAGE VENOUS RETURN CANNULA

    MDR report key: 189634 · Received September 25, 1998

    Report

    Report Number
    1649139-1998-00001
    Event Type
    Injury
    Date Received
    September 25, 1998
    Date of Event
    August 25, 1998
    Report Date
    September 25, 1998
    Manufacturer
    CHASE MEDICAL
    Product Code
    DWF
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SN
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    A FACSIMILE REPORT WAS SENT TO CHASE MEDICAL BY THE CHASE MEDICAL DISTRIBUTOR IN SINGAPORE ON 8/27/98 INDICATING THAT DURING USE A DUAL STAGE VENOUS RETURN CANNULA (PRODUCT CODE DWF-3651S) SEPARATED INTO TWO PIECES AT A LOCAL HOSP ON AUGUST 25, 1998. THE CANNULA PERFORMED PER ITS INTENDED USE AND THE PROCEDURE WAS COMPLETED SUCCESSFULLY. THE PT WAS DISCHARGED FROM THE HOSP FOLLOWING RECOVERY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DUAL STAGE VENOUS RETURN CANNULA DUAL STAGE VENOUS RETURN CANNULA DWF CHASE MEDICAL DWF-3651S 9806071

    Patients

    Seq Age Sex Outcome Treatment
    1 57 YR Other