inforMED
MalfunctionFPB

MICRO-VOLUME EXTENSION SET

Received Jan 29, 2024

Report 1416980-2024-00214 · MDR key 18596202

Device

Generic name

Filter, Infusion Line

Model number

NA

Catalog number

2N3350

Lot number

ASKU

Product problems

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

Patient

NA · Unknown

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

Narrative

Additional Manufacturer Narrative

H10: 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.

Description of Event or Problem

IT WAS REPORTED THAT A NON-DEHP MICRO-VOLUME EXTENSION SET WAS CRACKED AND LEAKED AT THE FILTER AREA. THIS OCCURRED DURING PATIENT INFUSION WITH LASIX AND ATIVAN. THERE WAS NO REPORT OF PATIENT INJURY OR MEDICAL INTERVENTION ASSOCIATED WITH THIS EVENT. NO ADDITIONAL INFORMATION IS AVAILABLE.

Additional Manufacturer Narrative

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