inforMED
MalfunctionFPB

INTRAVASCULAR EXTENSION SETS AND ACCESSORIES

Received Apr 30, 2021 · Event occurred Apr 2, 2021

Report 1416980-2021-02533 · MDR key 11752115

Device

Generic name

Filter, Infusion Line

Model number

NA

Catalog number

2N3382

Lot number

ASKU

Product problems

  • Fluid/Blood Leak
  • Fluid/Blood Leak

Patient

Not reported

  • No Clinical Signs, Symptoms or Conditions
  • No Clinical Signs, Symptoms or Conditions

Narrative

Additional Manufacturer Narrative

THE DEVICE WAS NOT RETURNED, AND THE LOT NUMBER IS UNKNOWN; THEREFORE, A DEVICE ANALYSIS COULD NOT BE COMPLETED. SHOULD ADDITIONAL RELEVANT INFORMATION BECOME AVAILABLE, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

Additional Manufacturer Narrative

ADDITIONAL INFORMATION FOR H10: BASED ON FURTHER INVESTIGATION, THE MOST PROBABLE CAUSE WAS DETERMINED TO BE RELATED TO THE END USER/METHODS EXCEEDING THE PRODUCT PRESSURE SPECIFICATIONS OF 45PSI. SHOULD ADDITIONAL RELEVANT INFORMATION BECOME AVAILABLE, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

Additional Manufacturer Narrative

SHOULD ADDITIONAL RELEVANT INFORMATION BECOME AVAILABLE, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

Description of Event or Problem

IT WAS REPORTED A MICRO-VOLUME EXTENSION SET LEAKED. THE EVENT WAS FURTHER REPORTED AS THE ¿FENTANYL TUBING APPEARS TO BE LEAKING AT CAP CLOSEST TO THE FENTANYL SYRINGE¿. IT WAS OBSERVED ¿FROM THE BOTTOM OF THE CAP/CONNECTION¿. THE SET WAS REPLACED. THERE WAS NO REPORT OF PATIENT INJURY OR MEDICAL INTERVENTION ASSOCIATED WITH THIS EVENT. NO ADDITIONAL INFORMATION IS AVAILABLE.