BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MINICAP PD TRANSFER SET (EASY-LOCK) WITH TWIST CLAMP

    MDR report key: 196417 · Received November 5, 1998

    Report

    Report Number
    1423500-1998-01879
    Event Type
    Malfunction
    Date Received
    November 5, 1998
    Date of Event
    October 4, 1998
    Report Date
    October 4, 1998
    Manufacturer
    BAXTER HEALTHCARE CORP.
    Product Code
    KDJ
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    HOME PATIENT REPORTED TRANSFER SET BECAME DISCONNECTED FROM TITANIUM ADAPTOR DURING TREATMENT. RN REPORTED TRANSFER SET WAS CHANGED, AND HOME PATIENT WAS TREATED WITH 1 GM ANCEF IP X 1 AND 80 MG GENTAMICIN IP X 1, AS A PRECAUTION. NO HOME PATIENT INJURY REPORTED AS PER RN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MINICAP PD TRANSFER SET (EASY-LOCK) WITH TWIST CLAMP TRANSFER SET KDJ BAXTER HEALTHCARE CORP. NA NA01

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN