FDA Adverse Event Malfunction Summary report: N

ARROW CANNON II PLUS REPLACEMENT HUB SET

MDR report key: 20127895 · Received September 3, 2024

Report

Report Number
9680794-2024-00851
Event Type
Malfunction
Date Received
September 3, 2024
Date of Event
August 12, 2024
Report Date
August 13, 2024
Manufacturer
ARROW INTERNATIONAL LLC
Product Code
NFK
UDI-DI
00801902096111
PMA / PMN Number
K020430
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CH
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

QN# (B)(4). COMPLAINT VERIFICATION TESTING COULD NOT BE PERFORMED AS NO SAMPLE WAS RETURNED FOR ANALYSIS. A DEVICE HISTORY RECORD REVIEW WAS PERFORMED AND NO RELEVANT FINDINGS WERE IDENTIFIED. WITHOUT THE DEVICE TO EVALUATE THE COMPLAINT COULD NOT BE CONFIRMED AND THE PROBABLE CAUSE COULD NOT BE DETERMINED FROM THE AVAILABLE INFORMATION. TELEFLEX WILL CONTINUE TO MONITOR AND TREND FOR REPORTS OF THIS NATURE. IF THE SAMPLE BECOMES AVAILABLE AT A LATER DATE A FOLLOW UP REPORT WILL BE SUBMITTED WITH INVESTIGATION RESULTS.

Additional Manufacturer Narrative · 0

(B)(4).

Description of Event or Problem · 0

IT WAS REPORTED "THE DOCTOR FOUND THE LUER HUB DAMAGED DURING USE ON THE PATIENT." THE USER CHANGED TO A NEW SET. THERE WAS NO MEDICAL INTERVENTION REQUIRED. THE PATIENT'S CONDITION IS REPORTED AS "FINE".

Description of Event or Problem · 0

IT WAS REPORTED "THE DOCTOR FOUND THE LUER HUB DAMAGED DURING USE ON THE PATIENT." THE USER CHANGED TO A NEW SET. THERE WAS NO MEDICAL INTERVENTION REQUIRED. THE PATIENT'S CONDITION IS REPORTED AS "FINE".

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
699920 ARROW CANNON II PLUS REPLACEMENT HUB SET KIT, REPAIR, CATHETER, HEMODI NFK ARROW INTERNATIONAL LLC 33F23C0882 00801902096111

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown NONE REPORTED.| NONE REPORTED.