BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TYCO HEALTHCARE - KENDALL

    MDR report key: 1942159 · Received December 23, 2010

    Report

    Report Number
    MW5018727
    Event Type
    Injury
    Date Received
    December 23, 2010
    Date of Event
    December 21, 2010
    Report Date
    December 23, 2010
    Manufacturer
    TYCO INTERNATIONAL LTD.
    Product Code
    MSD
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    BLUE PORT TUBING DISCONNECTED FROM CATHETER AFTER ATTEMPTED FLUSH. DATES OF USE: (B)(6)2010.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TYCO HEALTHCARE - KENDALL TRIPLE LUMEN HEMODIALYSIS CATHETER MSD TYCO INTERNATIONAL LTD. 009118

    Patients

    Seq Age Sex Outcome Treatment
    1 64 YR Disability