MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,distri report with the FDA on 2017-04-18 for HUDSON IN-LINE NEB TEE WITH VALVEM 1743 manufactured by Teleflex Medical.
[73095411]
(b)(4).
Patient Sequence No: 1, Text Type: N, H10
[73095412]
The customer alleges that there is a disconnection issue with the teleflex device and a vyaire product. No report of an injury or impact to the patient.
Patient Sequence No: 1, Text Type: D, B5
[80156080]
(b)(4). The sample was not returned for evaluation; therefore, the complaint could not be confirmed. If the sample is returned, a follow-up report will be submitted with investigation results.
Patient Sequence No: 1, Text Type: N, H10
[80156081]
The customer alleges that there is a disconnection issue with the teleflex device and a vyaire product. No report of an injury or impact to the patient.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3011137372-2017-00145 |
| MDR Report Key | 6500613 |
| Report Source | COMPANY REPRESENTATIVE,DISTRI |
| Date Received | 2017-04-18 |
| Date of Report | 2017-04-12 |
| Date of Event | 2017-01-25 |
| Date Mfgr Received | 2017-06-05 |
| Date Added to Maude | 2017-04-18 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | KATHARINE TARPLEY |
| Manufacturer Street | 3015 CARRINGTON MILL BLVD |
| Manufacturer City | MORRISVILLE NC 27560 |
| Manufacturer Country | US |
| Manufacturer Postal | 27560 |
| Manufacturer Phone | 9194334854 |
| Manufacturer G1 | TELEFLEX MEDICAL |
| Manufacturer Street | 3015 CARRINGTON MILL BLVD |
| Manufacturer City | MORRISVILLE NC 27560 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 27560 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | HUDSON IN-LINE NEB TEE WITH VALVEM |
| Generic Name | TUBING, PRESSURE & ACCESSORIES |
| Product Code | BYX |
| Date Received | 2017-04-18 |
| Catalog Number | 1743 |
| Lot Number | UNKNOWN |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | TELEFLEX MEDICAL |
| Manufacturer Address | RESEARCH TRIANGLE PARK NC |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2017-04-18 |