FDA Adverse Event Malfunction Summary report: N

36CM PERM CATH KIT X5

MDR report key: 2489656 · Received March 8, 2012

Report

Report Number
1317749-2012-00062
Event Type
Malfunction
Date Received
March 8, 2012
Date of Event
February 17, 2012
Report Date
February 17, 2012
Manufacturer
COVIDIEN
Product Code
LFJ
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CH
Reporter Occupation
NURSE

Narratives

Additional Manufacturer Narrative · 1

(B)(4). AN INVESTIGATION IS CURRENTLY UNDERWAY. UPON COMPLETION, THE RESULTS WILL BE FORWARDED.

Description of Event or Problem · 1

IT WAS REPORTED TO COVIDIEN ON (B)(4) 2012 THAT A CUSTOMER HAD AN ISSUE WITH A DIALYSIS CATHETER. THE CUSTOMER STATES THE CATHETER LEAKS, AS SMALL HOLES WERE DISCOVERED ON ITS VEINAL END. PATIENT WAS INVOLVED BUT WITH NO INJURY. THE CATHETER WAS PULLED AND REPLACED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 36CM PERM CATH KIT X5 DIALYSIS CATHETER LFJ COVIDIEN 8817748001 026628

Patients

Seq Age Sex Outcome Treatment
1 UNK