BEUDAMED
    FDA Adverse Event Summary report: N

    DISCOFIX 4 WAY STOPCOCK

    MDR report key: 2102216 · Received May 17, 2011

    Report

    Report Number
    2102216
    Date Received
    May 17, 2011
    Date of Event
    May 4, 2011
    Report Date
    May 17, 2011
    Manufacturer
    B/BRAUN
    Product Code
    FMG
    Report Source
    User Facility report
    Reporter Location
    PA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    THE PATIENT HAD A CENTRAL LINE. THE CENTRAL LINE BACKED UP ON TWO DIFFERENT DAYS. PRODUCTS WERE CHANGED 4 TIMES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DISCOFIX 4 WAY STOPCOCK STOPCOCK FMG B/BRAUN D500 N/A (LOT ON UNIT--11A2892041
    2 MICROLCLAVE NEEDLEFREE CONNECTOR FPA ICU MEDICAL, INC. B3300 N/A- ON UNIT 2249685

    Patients

    Seq Age Sex Outcome Treatment
    1 2 * CARDIAC DRUGS