inforMED
MalfunctionFPK

Q2 CHECKMATE EXTENSION SET

Received Feb 27, 2019 · Event occurred Jan 30, 2019

Report 1649914-2019-00009 · MDR key 8376214

Device

Generic name

Intravascular Administration Set

Model number

9545

Catalog number

9545

Product problems

  • Fluid/Blood Leak
  • Fluid/Blood Leak

Patient

Not reported

  • No Consequences Or Impact To Patient
  • No Consequences Or Impact To Patient

Narrative

Additional Manufacturer Narrative

THE DEVICE WAS NOT RETURNED FOR EVALUATION. A DHR REVIEW COULD NOT BE COMPLETED AS THE LOT NUMBER WAS NOT PROVIDED. THE ROOT CAUSE OF THE REPORTED COMPLAINT CONDITION IS UNKNOWN. QUEST WILL CONTINUE TO MONITOR COMPLAINT TRENDS.

Description of Event or Problem

A REPORT WAS RECEIVED REGARDING AN ALLEGED ISSUE ENCOUNTERED DURING USE OF THE INTRAVENOUS ADMINISTRATION EXTENSION SET. THE REPORT STATES THAT THE MANIFOLD LEAKED DURING SURGERY RESULTING IN A DELAY IN PROCEDURE. NO PICTURE OF THE PRODUCT IS AVAILABLE AND THE DEVICE IS NOT AVAILABLE FOR RETURN.