BEUDAMED
    FDA Adverse Event Other Summary report: N

    INTERLINK T-CONNECTOR EXTENSION SET

    MDR report key: 562993 · Received February 27, 2004

    Report

    Report Number
    6000001-2004-00333
    Event Type
    Other
    Date Received
    February 27, 2004
    Date of Event
    January 30, 2004
    Report Date
    February 2, 2004
    Manufacturer
    BAXTER HEALTHCARE CORP.
    Product Code
    FPA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NV, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    ACCOUNT REPORTED THAT THE RUBBER INJECTION PORT POPPED WHILE INJECTION STERIODS AND ISOVIEW 300 CONTRAST. REPORTEDLY, SOLUTION AND INJECTION PORT SQUIRTED INTO PHYSICIAN'S FACE. NO INJURY OR MEDICAL INTERVENTION REQUIRED BY PHYSICIAN OR PT. IT WAS REPORTED THAT PHYSICIAN WAS WEARING GLASSES AT THE TIME OF REPORTED INCIDENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 INTERLINK T-CONNECTOR EXTENSION SET T-CONNECTOR FPA BAXTER HEALTHCARE CORP. NA NA01

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN ISOVIEW 300 CONTRAST, MFR UNK, 2004