MAUDE MDR 8092575

MDR report key
8092575
Report number
3012307300-2018-08196
Event key
0
Event type
3
Date received
2018-11-20
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
DAVE HALVERSON
Address
6000 NATHAN LANE NORTH MINNEAPOLIS MN 55442 US
Phone
763-763-7633
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1PORTEX? EPIDURAL MINIPACKSSPINAL EPIDURAL ANESTHESIA KITSMITHS MEDICAL ASD, INC.OFTR N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12018-11-200

Event Narratives#

D

Patient 1

THE CUSTOMER HAS REPORTED THE SYRINGE HAS CRACKED ON A SMITHS MEDICAL PAIN MANAGEMENT EPIDURAL TRAY.