MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2018-05-18 for ARROW CANNON II PLUS REPLACEMENT HUB SET CAR-02400 manufactured by Arrow International Inc..
[108729342]
(b)(4)
Patient Sequence No: 1, Text Type: N, H10
[108729343]
The customer reports the catheter juncture was found cracked and leaking which could not work during the dressing change by the nurse. A second device used with same outcome (documented in mdr #1036844-2018-00148).
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1036844-2018-00147 |
| MDR Report Key | 7526791 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2018-05-18 |
| Date of Report | 2018-05-08 |
| Date of Event | 2018-02-12 |
| Date Mfgr Received | 2018-06-21 |
| Device Manufacturer Date | 2016-10-13 |
| Date Added to Maude | 2018-05-18 |
| 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 |
| Reporter Occupation | OTHER HEALTH CARE PROFESSIONAL |
| 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 | ARROW INTERNATIONAL INC. |
| Manufacturer Street | 312 COMMERCE PLACE |
| Manufacturer City | ASHEBORO NC 27203 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 27203 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | ARROW CANNON II PLUS REPLACEMENT HUB SET |
| Generic Name | KIT, REPAIR, CATHETER, HEMODI |
| Product Code | NFK |
| Date Received | 2018-05-18 |
| Catalog Number | CAR-02400 |
| Lot Number | 23F16J0471 |
| Device Expiration Date | 2019-09-30 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ARROW INTERNATIONAL INC. |
| Manufacturer Address | READING PA |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2018-05-18 |