BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    AQUASTAT SFR STERILE FIELD READY FLUSH SYRINGE

    MDR report key: 9219278 · Received October 21, 2019

    Report

    Report Number
    MW5090532
    Event Type
    Malfunction
    Date Received
    October 21, 2019
    Date of Event
    October 17, 2019
    Report Date
    October 18, 2019
    Manufacturer
    AQUABILITI
    Product Code
    NGT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    SALINE FLUSH SYRINGE END SHEARED OFF AS IT WAS BEING SCREWED ON TO THE LUER LOCK CAP OF A PICC.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1006938 AQUASTAT SFR STERILE FIELD READY FLUSH SYRINGE SALINE, VASCULAR ACCESS FLUSH NGT AQUABILITI KH04631

    Patients

    Seq Age Sex Outcome Treatment
    1 93 YR