BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SILHOUETTE

    MDR report key: 433558 · Received December 11, 2002

    Report

    Report Number
    8021545-2002-00242
    Event Type
    Malfunction
    Date Received
    December 11, 2002
    Date of Event
    April 29, 2002
    Report Date
    December 6, 2002
    Manufacturer
    MAERSK MEDICAL A/S
    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 INFUSION SET WAS LEAKING. ON NOVEMBER 22, 2002 MAERSK MEDICAL A/S RECEIVED THE COMPLAINT AND 1 USED TUBING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SILHOUETTE SUBCUTANEOUS INFUSION SET FPA MAERSK MEDICAL A/S COMBO 23" 529747

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other INSULIN, INFUSION PUMP AND SYRINGE/RESERVOIR.