MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2018-12-27 for 18" EXTENSION TUBE WITH CONNECTOR, STERILE 4A4194 manufactured by C.r. Bard, Inc. (covington) -1018233.
[131598577]
The investigation is still in progress. Once the investigation is complete, a supplemental report will be filed.
Patient Sequence No: 1, Text Type: N, H10
[131598578]
It was reported that the packaging was labeled for (b)(4) but contained the brown colored latex tubing which coincides with (b)(4).
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1018233-2018-06211 |
| MDR Report Key | 8200602 |
| Date Received | 2018-12-27 |
| Date of Report | 2018-12-27 |
| Date Mfgr Received | 2018-12-06 |
| Date Added to Maude | 2018-12-27 |
| 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 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | YONIC ANDERSON |
| Manufacturer Street | 8195 INDUSTRIAL BLVD |
| Manufacturer City | COVINGTON GA 30014 |
| Manufacturer Country | US |
| Manufacturer Postal | 30014 |
| Manufacturer Phone | 7707846100 |
| Manufacturer G1 | C.R. BARD, INC. (COVINGTON) -1018233 |
| Manufacturer Street | 8195 INDUSTRIAL BLVD |
| Manufacturer City | COVINGTON GA 30014 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 30014 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | 18" EXTENSION TUBE WITH CONNECTOR, STERILE |
| Generic Name | PVC EXTENSION TUBING |
| Product Code | FAQ |
| Date Received | 2018-12-27 |
| Returned To Mfg | 2018-12-21 |
| Catalog Number | 4A4194 |
| Lot Number | NGCV2806 |
| Operator | LAY USER/PATIENT |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | C.R. BARD, INC. (COVINGTON) -1018233 |
| Manufacturer Address | 8195 INDUSTRIAL BLVD COVINGTON GA 30014 US 30014 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2018-12-27 |