inforMED
MalfunctionFPK

LTXFR LGE BORE Y-IRR

Received Nov 27, 2013 · Event occurred Oct 30, 2013

Report 9613251-2013-00299 · MDR key 3723380

Device

Generic name

79gbx

Manufacturer

Hospira Ltd.

Model number

NA

Catalog number

06599

Lot number

24120NS

Product problems

  • Fluid/Blood Leak

Patient

NA

  • No Patient Involvement

Narrative

Description of Event or Problem

THE CUSTOMER CONTACT REPORTED A LEAK. THE PIERCING PINS OF THE BIFURCATED TUBING SET WERE TO BE USED TO DELIVER TWO 3000 ML CONTAINERS OF NORMAL SALINE VIA GRAVITY. IT WAS REPORTED THAT DURING PRIMING PRIOR TO PT USE, AN UNSPECIFIED VOLUME OF SOLUTION LEAKED FROM THE DISTAL END OF ONE OF THE TWO PIERCING PINS OF THE BIFURCATED TUBING SET. THE TUBING SET WAS REPLACED AND THE THERAPY WAS INITIATED. THOUGH REQUESTED, NO ADDITIONAL INFO WAS PROVIDED.

Additional Manufacturer Narrative

THE DEVICE WAS RECEIVED. INVESTIGATION IS NOT COMPLETE. THIS REPORT REPRESENTS ALL THE INFORMATION KNOWN BY THE REPORTER UPON QUERY BY HOSPIRA PERSONNEL.