BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PRIMARY IV PLUMSET

    MDR report key: 2220464 · Received August 17, 2011

    Report

    Report Number
    MW5021812
    Event Type
    Malfunction
    Date Received
    August 17, 2011
    Date of Event
    August 15, 2011
    Report Date
    August 17, 2011
    Manufacturer
    HOSPIRA
    Product Code
    FPA
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    FL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    THE CONNECTION BELOW THE CLAVE SEPARATED. PLEASE NOTE I HAVE SUBMITTED THIS REPORT WITH A DATE AS THERE WAS NO INVOLVEMENT WITH A PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PRIMARY IV PLUMSET IV PUMP TUBING FPA HOSPIRA 11943-12 05120

    Patients

    Seq Age Sex Outcome Treatment
    1