BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ASH SPLIT CATHETER

    MDR report key: 387918 · Received April 12, 2002

    Report

    Report Number
    2518902-2002-00054
    Event Type
    Injury
    Date Received
    April 12, 2002
    Date of Event
    February 22, 2002
    Report Date
    March 29, 2002
    Manufacturer
    MEDCOMP
    Product Code
    MSD
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IN, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THERE WAS A "BREAK IN CATHETER ARTERIAL SIDE AT CONNECTOR OF "Y".

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ASH SPLIT CATHETER HEMODIALYSIS CATHETER MSD MEDCOMP NA M030430

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR Required Intervention