BEUDAMED
    FDA Adverse Event Other Summary report: N

    FILTERFLOW

    MDR report key: 615313 · Received June 16, 2005

    Report

    Report Number
    2647836-2005-00002
    Event Type
    Other
    Date Received
    June 16, 2005
    Date of Event
    April 23, 2005
    Report Date
    May 25, 2005
    Manufacturer
    B. BRAUN MEDICAL , INC.
    Product Code
    FPB
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    AS REPORTED BY THE USER FACILITY ON THE MEDWATCH FORM: IV FILTER TUBING DISCONNECTED AT THE FILTER AND WAS FOUND ON THE PATIENT'S FLOOR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 FILTERFLOW SMALLBORE FILTERED EXTENSION SET FPB B. BRAUN MEDICAL , INC. NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 8 MO Other| R