BEUDAMED
    FDA Adverse Event Other Summary report: N

    CHURCHILL 60" EXTENSION TUBING

    MDR report key: 212300 · Received February 19, 1999

    Report

    Report Number
    212300
    Event Type
    Other
    Date Received
    February 19, 1999
    Date of Event
    February 10, 1999
    Report Date
    February 17, 1999
    Manufacturer
    CHURCHILL MEDICAL SYSTEMS, INC.
    Product Code
    FPA
    Report Source
    User Facility report
    Reporter Location
    OH, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    WHEN DISCONNECTING THE SYRINGE FROM THE TUBING THE RIB INSIDE THE LUER LOCK BROKE OFF INSIDE THE TUBING. THIS OCCURRED ON FOUR SEPARATE OCCASIONS. TWICE WITH CHEMO, THEREFORE, UNABLE TO ADMINISTER FINAL 1.2 OF CHEMO DRUGS TO PATIENTS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CHURCHILL 60" EXTENSION TUBING SYRINGE PUMP TUBING FPA CHURCHILL MEDICAL SYSTEMS, INC. AMS-638A UNK (SAMPLES AVAILABLE)

    Patients

    Seq Age Sex Outcome Treatment
    1 * Other