BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    DOUBLE T-CONNECTOR WITH 4 INCH EXTENSION SET

    MDR report key: 485746 · Received September 18, 2003

    Report

    Report Number
    1526863-2003-00090
    Event Type
    Malfunction
    Date Received
    September 18, 2003
    Report Date
    August 28, 2003
    Manufacturer
    MEDEX
    Product Code
    FKB
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    THE REPORTER STATED THAT THE MALE LUER BROKE OFF WHEN TRYING TO CONNECT. NO PATIENT INJURY OR TREATMENT ASSOCIATED WITH THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DOUBLE T-CONNECTOR WITH 4 INCH EXTENSION SET T-CONNECTOR FKB MEDEX NA 33D070097

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN