BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    T CONNECTOR

    MDR report key: 611673 · Received May 26, 2005

    Report

    Report Number
    1526863-2005-00030
    Event Type
    Malfunction
    Date Received
    May 26, 2005
    Report Date
    April 27, 2005
    Manufacturer
    MEDEX, INC.
    Product Code
    FKB
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    THE REPORTER STATED THAT THE TUBING WAS SEPARATING FROM THE FEMALE LUER LOCK. NO FURTHER INFO AVAILABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 T CONNECTOR T-CONNECTOR FKB MEDEX, INC. NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN