MalfunctionFOX
STATLOCK
Received May 24, 2021 · Event occurred Apr 30, 2021
Report 3006260740-2021-01980 · MDR key 11873136
Device
Generic name
Stand, Infusion
Manufacturer
C.r. Bard, Inc. (basd) -3006260740Model number
N/ACatalog number
UNKNOWN
Lot number
UNKNOWN
Product problems
- Detachment of Device or Device Component
- Detachment of Device or Device Component
Patient
Not reported
- No Clinical Signs, Symptoms or Conditions
- No Clinical Signs, Symptoms or Conditions
Narrative
Additional Manufacturer Narrative
THE DEVICE HAS NOT BEEN RETURNED TO THE MANUFACTURER FOR EVALUATION. A LOT HISTORY REVIEW (LHR) REVIEW IS NOT POSSIBLE, AS NO MANUFACTURING LOT NUMBER HAS BEEN PROVIDED BY THE COMPLAINANT.
Description of Event or Problem
IT WAS REPORTED A NURSE HAD PROBLEMS WITH THE BUTTON PART ITSELF COMING LOOSE FROM THE SKIN ADHESIVE. NO OTHER INFORMATION WAS PROVIDED.