BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    *

    MDR report key: 3915375 · Received June 24, 2014

    Report

    Report Number
    3915375
    Event Type
    Malfunction
    Date Received
    June 24, 2014
    Date of Event
    June 17, 2014
    Report Date
    June 24, 2014
    Manufacturer
    CAREFUSION 303, INC
    Product Code
    FPA
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    NURSE WENT TO SPIKE THE IV BAG AND THE IV TUBING BROKE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    367517 * SET, ADMINISTRATION, INTRAVASCULAR FPA CAREFUSION 303, INC MS3500-15 *

    Patients

    Seq Age Sex Outcome Treatment
    1 *