BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PILLING HEPARIN CANNULA 1.5MM TIP 2 1/8"

    MDR report key: 2180801 · Received April 29, 2011

    Report

    Report Number
    1044475-2011-00047
    Event Type
    Malfunction
    Date Received
    April 29, 2011
    Date of Event
    March 31, 2011
    Report Date
    April 4, 2011
    Manufacturer
    TELEFLEX MEDICAL
    Product Code
    DWF
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NJ, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    NO SAMPLE IS AVAILABLE FOR INVESTIGATION. INVESTIGATION IS INCOMPLETE AT THE TIME OF THIS REPORT. A F/U REPORT WILL BE SUBMITTED WHEN INVESTIGATION IS COMPLETE.

    Description of Event or Problem · 1

    THE EVENT IS REPORTED AS: SHAFT CAME OUT OF THE LUER LOCK CONNECTION DURING A PROCEDURE. NO REPORTED PT INJURY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PILLING HEPARIN CANNULA 1.5MM TIP 2 1/8" HEPARIN CANNULA DWF TELEFLEX MEDICAL NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1