BEUDAMED
    FDA Adverse Event Summary report: N

    BLOOD ADMINISTRATION SET

    MDR report key: 3070490 · Received April 16, 2013

    Report

    Report Number
    MW5029845
    Date Received
    April 16, 2013
    Date of Event
    April 2, 2013
    Report Date
    April 16, 2013
    Manufacturer
    B BRAUN
    Product Code
    BRZ
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    FL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    EVENT TUBING - SPIKED BLOOD Y-SET TO FLUID, WAS NOT ABLE TO GET FLUID TO FLOW THROUGH THE SYSTEM. EVENT TUBING - PRACTITIONER SQUEEZED THE BLOOD Y-SET TO DELIVER FLUID TO THE PT; THE BALL GOT CAUGHT UP IN THE TUBING AND DID NOT ALLOW THE FLUID TO MOVE THROUGHOUT THE TUBING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    164165 BLOOD ADMINISTRATION SET BLOOD ADMINISTRATION SET BRZ B BRAUN 375154 0061283058
    164166 BLOOD ADMINISTRATION SET BLOOD ADMINISTRATION SET BRZ B. BRAUN 375154 0061283058

    Patients

    Seq Age Sex Outcome Treatment
    1 33 YR