BEUDAMED
    FDA Adverse Event Other Summary report: N

    DEROYAL MANIFOLD IN ANGIOGRAPHY PACK

    MDR report key: 480193 · Received August 13, 2003

    Report

    Report Number
    1423395-2003-00005
    Event Type
    Other
    Date Received
    August 13, 2003
    Date of Event
    June 15, 2003
    Report Date
    August 13, 2003
    Manufacturer
    MEDLINE INDUSTRIES, INC.
    Product Code
    DTL
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MO, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    DURING A PROCEDURE A BUBBLE IN THE LINE WAS DETECTED BUT WAS PREVENTED FROM PROGRESSING. THE PT WAS NOT INJURED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DEROYAL MANIFOLD IN ANGIOGRAPHY PACK MANIFOLD IN CONVENIENCE KIT DTL MEDLINE INDUSTRIES, INC. 29599 IN DYNJ25578 26427

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other