BEUDAMED
    FDA Adverse Event Summary report: N

    VERIFUSE ADMINISTRATION SET

    MDR report key: 22869 · Received June 27, 1995

    Report

    Report Number
    MW1006357
    Date Received
    June 27, 1995
    Date of Event
    June 13, 1995
    Report Date
    June 21, 1995
    Manufacturer
    BLOCK MEDICAL, INC.
    Product Code
    FPA
    Report Source
    Voluntary report
    Reporter Location
    WA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    ADMINISTRATION SETS LEAKED ONTO PUMP. MFR NOTIFIED. FACTORY IS SENDING REPLACEMENT ADMINISTRATION SETS. OK TO USE EXISTING SETS ON NON-LIPID IV'S.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 VERIFUSE ADMINISTRATION SET IV TPN TUBING FPA BLOCK MEDICAL, INC. V021014 51325

    Patients

    Seq Age Sex Outcome Treatment
    1 *