9 LITER ACCESSORY DRAIN BAG (1 SP-418) 6033765

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2010-02-07 for 9 LITER ACCESSORY DRAIN BAG (1 SP-418) 6033765 manufactured by Gambro Renal Products.

Event Text Entries

[20933405] Patient on crrt (continuous renal replacement therapy)with nine liter effluent bag in use. The effluent bag spontaneously ruptured at seams spilling large volume of effluent on the floor, nurse, and equipment. The bag was immediately changed. There was no adverse effect to patient.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1601429
MDR Report Key1601429
Date Received2010-02-07
Date of Report2010-02-07
Date of Event2009-12-21
Report Date2010-02-07
Date Reported to FDA2010-02-07
Date Added to Maude2010-02-17
Event Key0
Report Source CodeUser Facility report
Manufacturer LinkN
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
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 Name9 LITER ACCESSORY DRAIN BAG (1 SP-418)
Generic NameBAG, DRAINAGE, CRRT
Product CodeFII
Date Received2010-02-07
Returned To Mfg2010-01-06
Model NumberNA
Catalog Number6033765
Lot NumberNA
ID Number*
Device AvailabilityR
Device Age1 DY
Device Sequence No1
Device Event Key0
ManufacturerGAMBRO RENAL PRODUCTS
Manufacturer Address14143 DENVER WEST PARKWAY SUIT LAKEWOOD CO 80401 US 80401


Patients

Patient NumberTreatmentOutcomeDate
10 2010-02-07

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