inforMED
MalfunctionFPB

MICRO-VOLUME EXTENSION SET

Received Jan 20, 2023 · Event occurred Dec 16, 2022

Report 1416980-2023-00096 · MDR key 16218452

Device

Generic name

Filter, Infusion Line

Model number

NA

Catalog number

2N3350

Lot number

ASKU

Product problems

  • Fluid/Blood Leak
  • Fluid/Blood Leak

Patient

Unknown

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

Narrative

Additional Manufacturer Narrative

H10: FIFTEEN (15) ACTUAL SAMPLES WERE RECEIVED FOR EVALUATION. VISUAL INSPECTION USING THE NAKED EYE DID NOT IDENTIFY ANY ABNORMALITIES THAT COULD HAVE CONTRIBUTED TO THE REPORTED CONDITION. ALL COMPONENTS WERE CORRECTLY PLACED AND ACCORDING TO SPECIFICATIONS. FUNCTIONAL TESTING WAS PERFORMED INCLUDING CLEAR PASSAGE AND PRESSURE TESTING AND NO BLOCKAGE WERE OBSERVED. THE REPORTED CONDITION WAS NOT VERIFIED IN THE 15 SAMPLES. 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 UNSPECIFIED QUANTITY OF NON-DEHP MICRO-VOLUME EXTENSION SETS WERE LEAKING COMING FROM THE FILTER. THIS WAS OBSERVED DURING PATIENT INFUSION. THERE WAS NO REPORT OF PATIENT INJURY OR MEDICAL INTERVENTION ASSOCIATED WITH THIS EVENT. NO ADDITIONAL INFORMATION IS AVAILABLE.