BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PALINDROME SAPPHIRE 23/40KT VT

    MDR report key: 3843540 · Received February 11, 2014

    Report

    Report Number
    3009211636-2014-00001
    Event Type
    Malfunction
    Date Received
    February 11, 2014
    Date of Event
    February 4, 2014
    Report Date
    February 4, 2014
    Manufacturer
    COVIDIEN
    Product Code
    MSD
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MX
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    SUBMIT DATE: 02/11/2014. 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)(6) 2014 THAT A CUSTOMER HAD AN ISSUE WITH A DIALYSIS CATHETER. THE CUSTOMER STATES THAT THERE WAS A CRACK IN THE ARTERIAL CONNECTOR. THE CATHETER WAS PULLED AND REPLACED WITH A NEW ONE. NO PATIENT INJURY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    90242 PALINDROME SAPPHIRE 23/40KT VT DIALYSIS CATHETER MSD COVIDIEN 8888145048C UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK