BEUDAMED
    FDA Adverse Event Summary report: N

    MEDISYSTEMS

    MDR report key: 3141233 · Received May 10, 2013

    Report

    Report Number
    3141233
    Date Received
    May 10, 2013
    Date of Event
    April 27, 2013
    Report Date
    April 30, 2013
    Manufacturer
    MEDISYSTEMS
    Product Code
    FJK
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    VENOUS LINE FROM PATIENT'S CATHETER DISCONNECTED, AND THERE WAS BLOOD LOSS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    209632 MEDISYSTEMS STREAMLINE AIRLESS SYSTEM SET FJK MEDISYSTEMS SL-2000M2095 3025511

    Patients

    Seq Age Sex Outcome Treatment
    1 65 YR Death