BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CENTRY SYSTEM BLOOD TUBING

    MDR report key: 22583 · Received June 20, 1995

    Report

    Report Number
    MW1006291
    Event Type
    Malfunction
    Date Received
    June 20, 1995
    Date of Event
    June 2, 1995
    Report Date
    June 2, 1995
    Manufacturer
    COBE RENAL CARE, INC.
    Product Code
    FJK
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    HI, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    AFTER RETRANSFUSION (BLOOD RETURNED TO PT), DIALYSIS WAS COMPLETED. RPTR ABOUT TO REMOVE TUBING FROM MACHINE WHEN THE TUBING (MED PORT), ATTACHED TO TOP PART OF VENOUS CHAMBER, FELL OFF.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CENTRY SYSTEM BLOOD TUBING BLOOD TUBING FJK COBE RENAL CARE, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1 75 YR