BEUDAMED
    FDA Adverse Event Other Summary report: N

    SURECAN SAFETY HUBER NEEDLE

    MDR report key: 507193 · Received January 6, 2004

    Report

    Report Number
    MW1030765
    Event Type
    Other
    Date Received
    January 6, 2004
    Date of Event
    January 2, 2004
    Report Date
    January 6, 2004
    Manufacturer
    BRAUN MEDICAL, INC.
    Product Code
    FMI
    Report Source
    Voluntary report
    Reporter Location
    CO, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PT HAD C.I. OF 5FU GOING FOR 4 DAYS VIA INFUSE PORT. CONNECTOR SITE STARTED TO LEAK. WHITE CONNECTOR PORT OF Y-TYPE HUBER NEEDLE. NEW CAP IN PLACE - NO FURTHER LEAKS. Y-SITE INFUSION SET AND NEEDLE ONE PIECE FROM MFR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SURECAN SAFETY HUBER NEEDLE INFUSION SET WITH RIGHT ANGLE SAFETY HUBER NEEDLE FMI BRAUN MEDICAL, INC. US 201 6H 60469828

    Patients

    Seq Age Sex Outcome Treatment
    1 65 YR Other