MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional,user faci report with the FDA on 2018-07-19 for B. BRAUN 8713112D manufactured by B. Braun Melsungen Ag.
[114546328]
(b)(4). The investigation into this reported event is ongoing. A follow-up report will be submitted when the results of the investigation are available.
Patient Sequence No: 1, Text Type: N, H10
[114546329]
As reported by user facility: hot prong burnt.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9610825-2018-00137 |
| MDR Report Key | 7702928 |
| Report Source | HEALTH PROFESSIONAL,USER FACI |
| Date Received | 2018-07-19 |
| Date of Report | 2018-10-15 |
| Date Facility Aware | 2018-06-20 |
| Report Date | 2018-10-15 |
| Date Reported to FDA | 2018-10-15 |
| Date Reported to Mfgr | 2018-10-15 |
| Date Mfgr Received | 2018-06-20 |
| Device Manufacturer Date | 2015-01-20 |
| Date Added to Maude | 2018-07-19 |
| 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 | BIOMEDICAL ENGINEER |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MR. JONATHAN SEVERINO |
| Manufacturer Street | 861 MARCON BLVD. |
| Manufacturer City | ALLENTOWN PA 18109 |
| Manufacturer Country | US |
| Manufacturer Postal | 18109 |
| Manufacturer Phone | 4842408332 |
| Manufacturer G1 | B. BRAUN MELSUNGEN AG |
| Manufacturer Street | CARL-BRAUN-STR. 1 |
| Manufacturer City | MELSUNGEN, HESSEN 34212 |
| Manufacturer Country | GM |
| Manufacturer Postal Code | 34212 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | B. BRAUN |
| Generic Name | ACCESSORIES, PUMP, INFUSION |
| Product Code | MRZ |
| Date Received | 2018-07-19 |
| Returned To Mfg | 2018-07-12 |
| Catalog Number | 8713112D |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | 3 YR |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | B. BRAUN MELSUNGEN AG |
| Manufacturer Address | CARL-BRAUN-STR. 1 MELSUNGEN, HESSEN 34212 GM 34212 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2018-07-19 |