BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BAXTER HEALTHCARE CORP

    MDR report key: 752768 · Received May 24, 2005

    Report

    Report Number
    MW1035573
    Event Type
    Injury
    Date Received
    May 24, 2005
    Date of Event
    May 16, 2005
    Report Date
    May 24, 2005
    Manufacturer
    BAXTER HEALTHCARE
    Product Code
    FPA
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    OH, US
    Reporter Occupation
    ATTORNEY

    Narratives

    Description of Event or Problem · 1

    PATIENT'S IV WAS LEAKING AT THE "Y" JUNCTION OF THE SET.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BAXTER HEALTHCARE CORP INTERLINK SYSTEM MINIVOLUME EXTENSION SET FPA BAXTER HEALTHCARE * *

    Patients

    Seq Age Sex Outcome Treatment
    1 16 YR Required Intervention