FDA Adverse Event
Malfunction
Summary report: N
TRIFURCATED POSIFLOW EXTENSION SET (17 IN)
MDR report key: 1950820
·
Received December 30, 2010
Report
- Report Number
- MW5018819
- Event Type
- Malfunction
- Date Received
- December 30, 2010
- Date of Event
- April 3, 2010
- Manufacturer
- ACACIA
- Product Code
- FPA
- Product Problem
- Yes
- Report Source
- Voluntary report
- Reporter Location
- CA, US
- Reporter Occupation
- RISK MANAGER
Narratives
Description of Event or Problem · 1
STAFF DISCOVERED TRIFUSE EXTENSION FILTER WARPED PRIOR TO PLACING ON PT.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | TRIFURCATED POSIFLOW EXTENSION SET (17 IN) | IV EXTENSION TUBING | FPA | ACACIA | F3061A | A3735 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 |