BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    VACUUM BOTTLE

    MDR report key: 2212152 · Received August 10, 2011

    Report

    Report Number
    2212152
    Event Type
    Malfunction
    Date Received
    August 10, 2011
    Date of Event
    August 6, 2011
    Report Date
    August 10, 2011
    Manufacturer
    HOSPIRA
    Product Code
    KDQ
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    AZ, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    A ONE-LITER VACUUM BOTTLE QUIT DRAINING FLUID AFTER APPROXIMATELY 300ML. ANOTHER BOTTLE WAS NEEDED TO FINISH DRAINING FLUID. THE BOTTLE WAS FROM THE SAME MANUFACTURER, BRAND NAME AND LOT NUMBER.THERE WERE NO OBSERVABLE PROBLEMS WITH THE BOTTLE THAT CONTRIBUTED TO THE EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 VACUUM BOTTLE 1 LITER VACUUM BOTTLE KDQ HOSPIRA * 96-098-DW-02

    Patients

    Seq Age Sex Outcome Treatment
    1 *