BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    QUICK SET

    MDR report key: 418831 · Received September 19, 2002

    Report

    Report Number
    8021545-2002-00169
    Event Type
    Malfunction
    Date Received
    September 19, 2002
    Date of Event
    July 30, 2002
    Report Date
    September 19, 2002
    Manufacturer
    MAERSK MEDICAL DEVICE SADECV
    Product Code
    FPA
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE END-USER'S PARENT STATED THAT THE SOFT CANNULA WAS AT 90 DEGREE ANGLE THIS MORNING AND MEDIUM KETONES. ON SEPTEMBER 09, 2002 MAERSK MEDICAL A/S RECEIVED THE COMPLAINT AND 1 USED AND 1 UNUSED INFUSION SETS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 QUICK SET SUBCUTANEOUS INFUSION SET FPA MAERSK MEDICAL DEVICE SADECV 23" - 6MM 2200223

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other 1.INSULIN, 2. INSULIN INFUSION PUMP.