BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    INTERMATE

    MDR report key: 4123229 · Received September 26, 2014

    Report

    Report Number
    1416980-2014-33479
    Event Type
    Malfunction
    Date Received
    September 26, 2014
    Report Date
    September 2, 2014
    Manufacturer
    BAXTER HEALTHCARE - IRVINE
    Product Code
    FRN
    PMA / PMN Number
    K910425
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4).SHOULD ADDITIONAL RELEVANT INFORMATION BECOME AVAILABLE, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

    Additional Manufacturer Narrative · 1

    (B)(4). ADDITIONAL INFORMATION: THIS LOT WAS MANUFACTURED FROM NOVEMBER 25, 2008 TO NOVEMBER 26, 2008. A BATCH REVIEW WAS CONDUCTED AND THERE WERE NO DEVIATIONS FOUND RELATED TO THIS REPORTED CONDITION DURING THE MANUFACTURE OF THIS LOT. THE DEVICE WAS NOT RECEIVED FOR EVALUATION; THEREFORE, A DEVICE ANALYSIS COULD NOT BE COMPLETED. SHOULD ADDITIONAL RELEVANT INFORMATION BECOME AVAILABLE, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT A LARGE VOLUME INTERMATE HAD A MISSING ¿BLUE TIP¿ OR A MISSING ¿TOP TIP¿. THERE WAS NO PATIENT INVOLVEMENT AS THIS WAS IDENTIFIFED BEFORE PATIENT USE. NO ADDITIONAL INFORMATION IS AVAILABLE. THIS IS REPORT 12 OF 12.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    602456 INTERMATE PUMP, INFUSION FRN BAXTER HEALTHCARE - IRVINE 08M048

    Patients

    Seq Age Sex Outcome Treatment
    1