MalfunctionFPK
12.5 IN (32 CM) Q2 T-EXTENSION SET W/ 3 Q2 CHECKVALVE T-SITES, IN-LINE CHECKVALV
Received Mar 17, 2025 · Event occurred Mar 8, 2025
Report 21617983 · MDR key 21617983
Device
Generic name
Tubing, Fluid Delivery
Manufacturer
Quest Medical IncModel number
95710Catalog number
95710
Lot number
74845
Patient
57 YR · Male
- No Clinical Signs, Symptoms or Conditions
- No Clinical Signs, Symptoms or Conditions
Narrative
Description of Event or Problem
IV EXTENSION SET CONNECTED TO PATIENT'S PICC [PERIPHERALLY INSERTED CENTRAL CATHETER] LINE WITH MULTIPLE DRIPS INFUSING. TWO END PORTS DISCONNECTED SPONTANEOUSLY FROM THE REST OF THE EXTENSION SET, AND BLOOD FOUND IN BED BY EKG TECH. DEVICE WAS DISCARDED.