inforMED
MalfunctionFPB

MICRO-VOLUME EXTENSION SET

Received Jul 1, 2021 · Event occurred Jun 3, 2021

Report 1416980-2021-04053 · MDR key 12103347

Device

Generic name

Filter, Infusion Line

Model number

NA

Catalog number

2N3342

Lot number

DR21B19031

Product problems

  • Crack
  • Fluid/Blood Leak
  • Crack
  • Fluid/Blood Leak

Patient

Not reported

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

Narrative

Additional Manufacturer Narrative

ADDITIONAL INFORMATION WAS ADDED TO H4, H6 AND H10. H10: A BATCH REVIEW WAS CONDUCTED AND THERE WERE NO DEVIATIONS FOUND RELATED TO THIS REPORTED CONDITION DURING THE MANUFACTURE OF THIS LOT. THE DEVICE WAS NOT RECEIVED FOR EVALUATION; THEREFORE, A DEVICE ANALYSIS COULD NOT BE COMPLETED. 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 THAT THE ¿PIG TAIL¿ OF A NON-DEHP THREE LEAD EXTENSION SET APPEARED CRACKED RESULTING IN A LEAK. THIS WAS OBSERVED PRIOR TO PATIENT USE. THERE WAS NO PATIENT INVOLVEMENT. NO ADDITIONAL INFORMATION IS AVAILABLE.