INTROCAN? SAFETY N/A 4251601-01

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a foreign,health professional report with the FDA on 2018-09-04 for INTROCAN? SAFETY N/A 4251601-01 manufactured by B. Braun Melsungen Ag.

Event Text Entries

[119039229] (b)(4). We received one introcan safety pur 24g, 0. 7x19mm-eu in original packaging. The returned introcan safety was taken to a visual inspection. Damages at the original packaged sample were not detected. Furthermore, the sample was checked by the dynamical tensile force according to test plan. Nominal (size g24): min. 3 n. Actual (size g24): 9. 43 n. The returned sample is within our specifications. Device history record review (dhr): reviewed the device history record and no abnormalities found during in process and final control inspection.
Patient Sequence No: 1, Text Type: N, H10


[119039230] As reported by the user facility ((b)(4)): cannula separated leaving tip in vein.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number9610825-2018-00181
MDR Report Key7841690
Report SourceFOREIGN,HEALTH PROFESSIONAL
Date Received2018-09-04
Date of Report2018-09-04
Date of Event2018-08-08
Date Facility Aware2018-09-04
Report Date2018-09-04
Date Reported to FDA2018-09-04
Date Reported to Mfgr2018-09-04
Date Mfgr Received2018-08-08
Device Manufacturer Date2017-10-15
Date Added to Maude2018-09-04
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationOTHER HEALTH CARE PROFESSIONAL
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMR. JONATHAN SEVERINO
Manufacturer Street861 MARCON BLVD.
Manufacturer CityALLENTOWN PA 18109
Manufacturer CountryUS
Manufacturer Postal18109
Manufacturer Phone4842408332
Manufacturer G1B. BRAUN MELSUNGEN AG
Manufacturer StreetCARL-BRAUN-STR. 1
Manufacturer CityMELSUNGEN, 34212
Manufacturer CountryGM
Manufacturer Postal Code34212
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameINTROCAN? SAFETY
Generic NameI.V. SAFETY CATHETER
Product CodeDQR
Date Received2018-09-04
Returned To Mfg2018-08-16
Model NumberN/A
Catalog Number4251601-01
Lot Number17L15G8391
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
Device Age10 MO
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerB. BRAUN MELSUNGEN AG
Manufacturer AddressCARL-BRAUN-STR. 1 MELSUNGEN, HESSEN 34212 GM 34212


Patients

Patient NumberTreatmentOutcomeDate
10 2018-09-04

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