BEUDAMED
    FDA Adverse Event Other Summary report: N

    ICU MED, INC 800- 824 -7890

    MDR report key: 746325 · Received September 29, 2005

    Report

    Report Number
    MW1036749
    Event Type
    Other
    Date Received
    September 29, 2005
    Date of Event
    September 23, 2005
    Report Date
    September 26, 2005
    Manufacturer
    ICU MEDICAL INC
    Product Code
    FPB
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    VA
    Reporter Occupation
    PHARMACIST

    Narratives

    Description of Event or Problem · 1

    PATIENT EXPERIENCED LEAKING AT THE FILTER PORTION OF HIS IV NAFCILLIN THAT WAS BEING ADMINISTERED VIA CADD-PRIZM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ICU MED, INC 800- 824 -7890 8IN. NON-DEHP SET, 0.2MICRON FILTER FPB ICU MEDICAL INC * 275098

    Patients

    Seq Age Sex Outcome Treatment
    1 55 YR Other