PLUNGER HOLDER/TRACK II NA

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 07 report with the FDA on 2004-12-09 for PLUNGER HOLDER/TRACK II NA manufactured by Medex.

Event Text Entries

[15487423] During in-house testing, the hex value was not greater than c0 on a plunger holder/track ii, which would have caused the syringe pump to fail to alert "load syringe plunger" or "occlusion' depending on the pump's software.
Patient Sequence No: 1, Text Type: D, B5


[15574291] During in-house testing, the hex value was not greater than c0 on the track, which would have caused a syringe pump to fail to alert "load syringe plunger" or "occlusion" depending on the pump's software. This was due to a nonfunctional dome switch on the long flex cable. Medex was able to confirm the issue and determine a cause. The plunger holder/track ii was repaired and returned to the customer. No add'l action is necessary at this time. Medex considers this mdr closed with this report.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number1036813-2004-00092
MDR Report Key798280
Report Source07
Date Received2004-12-09
Date of Report2004-11-09
Date of Event2004-11-09
Date Mfgr Received2004-11-09
Date Added to Maude2006-12-27
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location0
Manufacturer ContactTERRI DAVIS
Manufacturer Street6250 SHIER-RINGS RD
Manufacturer CityDUBLIN OH 43016
Manufacturer CountryUS
Manufacturer Postal43016
Manufacturer Phone6147915542
Manufacturer G1MEDEX
Manufacturer Street4350 RIVER GREEN PKWY, STE 200
Manufacturer CityDULUTH GA 30096
Manufacturer CountryUS
Manufacturer Postal Code30096
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NamePLUNGER HOLDER/TRACK II
Generic NamePLUNGER HOLDER/TRACK II
Product CodeFIH
Date Received2004-12-09
Model NumberPLUNGER HOLDER/TRA
Catalog NumberNA
Lot NumberNA
ID Number*
OperatorOTHER
Device AvailabilityY
Device Eval'ed by MfgrY
Implant FlagN
Date Removed*
Device Sequence No1
Device Event Key785813
ManufacturerMEDEX
Manufacturer Address* DULUTH GA 30096 US
Baseline Brand NamePLUNGER HOLDER/TRACK II
Baseline Generic NamePLUNGER HOLDER/TRACK II
Baseline Model NoPLUNGER HOLDER/
Baseline Catalog NoNA
Baseline ID*


Patients

Patient NumberTreatmentOutcomeDate
10 2004-12-09

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