BEUDAMED
    FDA Adverse Event Other Summary report: N

    NA

    MDR report key: 438509 · Received January 17, 2003

    Report

    Report Number
    2523676-2002-00082
    Event Type
    Other
    Date Received
    January 17, 2003
    Date of Event
    December 18, 2002
    Report Date
    January 9, 2003
    Manufacturer
    B. BRAUN MEDICAL, INC.
    Product Code
    FPB
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    AS REPORTED BY THE USER FACILITY: "V1903 LEAKED AT DRIP CHAMBER SPILLING CHEMO DURG ON PT".

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 NA SECONDARY ADMINISTRATION SETS FPB B. BRAUN MEDICAL, INC. V1903 60351814

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other