BEUDAMED
    FDA Adverse Event Summary report: N

    MALE ADAPTER

    MDR report key: 25637 · Received January 10, 1995

    Report

    Report Number
    25637
    Date Received
    January 10, 1995
    Report Date
    December 31, 1994
    Manufacturer
    ABBOTT LABORATORIES
    Product Code
    KNR
    Report Source
    User Facility report

    Narratives

    Description of Event or Problem · 1

    ATTEMPTED TO FLUSH CVP WITH DILUTED HEPARIN PER PROTOCOL. RUBBER STOPPER ON MALE ADAPTER COMPLETELY INVERTED ITSELF.INVALID DATA - REGARDING SINGLE USE LABELING OF DEVICE. PATIENT MEDICAL STATUS PRIOR TO EVENT: INVALID DATA. INVALID DATA - REGARDING MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY.INVALID DATA - REGARDING WHETHER EVENT PRESENTS IMMINENT HAZARD. INVALID DATA - WHETHER DEVICE USED AS LABELED/INTENDED.INVALID DATA - REGARDING EVALUATION BY USER AFTER EVENT. METHOD OF EVALUATION: INVALID DATA. RESULTS OF EVALUATION: INVALID DATA. CONCLUSION: INVALID DATA. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: INVALID DATA. CORRECTIVE ACTIONS: NO DATA. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MALE ADAPTER KNR ABBOTT LABORATORIES UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK Invalid Data