BEUDAMED
    FDA Adverse Event Death Summary report: N

    LOW VOLUME EXTENSION SET

    MDR report key: 401340 · Received June 18, 2002

    Report

    Report Number
    401340
    Event Type
    Death
    Date Received
    June 18, 2002
    Date of Event
    June 6, 2002
    Report Date
    June 13, 2002
    Manufacturer
    CODAN US CORPORATION
    Product Code
    FPA
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    NC, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    PEDIATRIC ENTERAL FEEDING SOLUTION INFUSED INTO PERIPHERAL VENOUS CATHETER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LOW VOLUME EXTENSION SET IV TUBING FPA CODAN US CORPORATION * 73693

    Patients

    Seq Age Sex Outcome Treatment
    1 5 YR Death CODAN US CORP - LUER LOCK-EXTENSION SET (BC576),| LOT# 73479.