BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LOCKING BLUNT CANNULA

    MDR report key: 4120692 · Received September 19, 2014

    Report

    Report Number
    4120692
    Event Type
    Malfunction
    Date Received
    September 19, 2014
    Date of Event
    April 29, 2014
    Report Date
    August 22, 2014
    Manufacturer
    CAREFUSION 303, INC.
    Product Code
    FPA
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    MI, US
    Reporter Occupation
    INVALID DATA

    Narratives

    Description of Event or Problem · 1

    WHEN RN WENT TO CHECK ON PATIENT, HER IV WAS UNSCREWED. THE ALLIGATOR CLIP WAS STILL PLUGGED INTO THE PORT, BUT THE LINE WAS UNATTACHED AND PUMPING IV FLUIDS ONTO BED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    583214 LOCKING BLUNT CANNULA SET, ADMINISTRATION, INTRAVASCULAR FPA CAREFUSION 303, INC. N/A 1370283901

    Patients

    Seq Age Sex Outcome Treatment
    1 *