inforMED
MalfunctionFPK

CHECKMATE INTRAVASCULAR ADMINISTRATION SET

Received Oct 29, 2014 · Event occurred Sep 25, 2014

Report 1649914-2014-00053 · MDR key 4211644

Device

Generic name

Intravascular Administration Set

Model number

9652

Product problems

  • Detachment Of Device Component

Patient

Not reported

  • No Known Impact Or Consequence To Patient

Narrative

Additional Manufacturer Narrative

QUEST MEDICAL, INC. HAS LIMITED INFORMATION RELATED TO THE PATIENT'S MEDICAL HISTORY AND IS UNABLE TO FORM AN OPINION AS TO THE RELEVANCY OF THE PATIENT'S HISTORY TO THE EVENT REPORTED. QUEST MEDICAL, INC. DEFERS TO THE PATIENT'S PHYSICIAN REGARDING MEDICAL HISTORY.

Description of Event or Problem

DURING A VISIT WITH THE HOSPITAL FACILITY, A QUEST MEDICAL REPRESENTATIVE WAS INFORMED OF SOME ISSUES WITH A FEW FLUID DELIVERY PRODUCTS. THIS REPORT STATED THAT WHILE THE DEVICE IS BEING REMOVED FROM THE STERILE PACKAGING, PART OF THE DEVICE DETACHES. IT WAS REPORTED THAT OCCASIONALLY THIS HAPPENS WHILE THE NURSE IS ATTEMPTING TO SPIKE THE IV BAG. THE REPORT STATED THAT THE DEVICE DETACHES AT THE LUER LOCK LOCATION. THERE WERE NO PATIENT COMPLICATIONS REPORTED AS A RESULT OF THE ALLEGED ISSUE. THE LOT NUMBER OF THE DEVICE WAS NOT NOTED BY THE HOSPITAL. ANY SAMPLE(S) WERE DISPOSED OF BY THE HOSPITAL AND NOT GIVEN TO THE MANUFACTUER FOR ANALYSIS.