BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TEXIUM SYRINGE ADAPTOR MOLDED TO SYRINGE 30 ML

    MDR report key: 8727479 · Received June 21, 2019

    Report

    Report Number
    MW5087563
    Event Type
    Malfunction
    Date Received
    June 21, 2019
    Date of Event
    May 29, 2019
    Report Date
    June 19, 2019
    Manufacturer
    BAXTER / CAREFUSION 303, INC.
    Product Code
    FPA
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    SC, US
    Reporter Occupation
    PHARMACIST

    Narratives

    Description of Event or Problem · 1

    TIP OF TEXIUM ADAPTOR ON SYRINGE BROKE WHILE PULLING UP CHEMOTHERAPY. UNABLE TO USE MEDICATION. FDA SAFETY REPORT ID# (B)(4).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    518906 TEXIUM SYRINGE ADAPTOR MOLDED TO SYRINGE 30 ML SET, ADMINISTRATION, INTRAVASCULAR FPA BAXTER / CAREFUSION 303, INC. MY8030 91908604

    Patients

    Seq Age Sex Outcome Treatment
    1