BEUDAMED
    FDA Adverse Event Other Summary report: N

    EXTENSION SET - 30 INCH WITH OPTION LOCK

    MDR report key: 52577 · Received July 30, 1996

    Report

    Report Number
    52577
    Event Type
    Other
    Date Received
    July 30, 1996
    Date of Event
    June 13, 1996
    Report Date
    June 25, 1996
    Manufacturer
    ABBOTT LABS
    Product Code
    FPA
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    PA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    MOTHER OF PT NOTED THAT MALE END OF CO'S 30 INCH EXTENSION SET DISCONNECTED FROM FEMALE END OF ANOTHER MFR'S CANNULA CONNECTED TO A SUBCLAVIAN LINE. HYPERALIMENTATION AND LIPIDS WERE INFUSING. A SIGNIFICANT AMOUNT OF THE HYPERALIMENTATION AND LIPIDS WERE WASTED, AND THERE WAS AN APPROX 10CC BLOOD LOSS. CBC AND BLOOD GLUCOSE PERFORMED. PT STABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 EXTENSION SET - 30 INCH WITH OPTION LOCK IV TUBING FPA ABBOTT LABS UNK UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 19 MO Other BECTON DICKINSON INTERLINK THREADED LOCK CANNULA