* 6033765

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2009-12-13 for * 6033765 manufactured by Gambro Renal Products, Inc..

Event Text Entries

[1449110] Continous renal replacement therapy (crrt)treatment proceeding when bag spontaneously burst a hole in the center of bag. Effluent was coming out of the bag onto the floor.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1560508
MDR Report Key1560508
Date Received2009-12-13
Date of Report2009-12-13
Date of Event2009-11-07
Report Date2009-12-13
Date Reported to FDA2009-12-13
Date Added to Maude2009-12-16
Event Key0
Report Source CodeUser Facility report
Manufacturer LinkN
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag0
Reporter OccupationRISK MANAGER
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location0
Single Use0
Previous Use Code0
Event Type3
Type of Report3

Device Details

Brand Name*
Generic NameEFFLUENT BAG, DRAINAGE
Product CodeFII
Date Received2009-12-13
Returned To Mfg2009-12-09
Model Number*
Catalog Number6033765
Lot Number0806791
ID Number*
Device AvailabilityR
Device Age1 DY
Device Sequence No1
Device Event Key0
ManufacturerGAMBRO RENAL PRODUCTS, INC.
Manufacturer Address14143 DENVER WEST PARKWAY, SUI LAKEWOOD CO 80401 US 80401


Patients

Patient NumberTreatmentOutcomeDate
10 2009-12-13

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