MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-01-22 for I.V. START KIT manufactured by Medline Industries, Inc..
[133754874]
Medline iv start kit cracked shortly after placement. Extension set tubing cracked at the end of the line. Lot number (10) 18gbe827.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 8267021 |
| MDR Report Key | 8267021 |
| Date Received | 2019-01-22 |
| Date of Report | 2019-01-09 |
| Date of Event | 2018-12-10 |
| Report Date | 2019-01-09 |
| Date Reported to FDA | 2019-01-09 |
| Date Reported to Mfgr | 2019-01-22 |
| Date Added to Maude | 2019-01-22 |
| Event Key | 0 |
| Report Source Code | User Facility report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Reporter Occupation | RISK MANAGER |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | I.V. START KIT |
| Generic Name | I.V. START KIT |
| Product Code | LRS |
| Date Received | 2019-01-22 |
| Lot Number | 18GBE827 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | * |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | MEDLINE INDUSTRIES, INC. |
| Manufacturer Address | THREE LAKES DRIVE NORTHFIELD IL 60093 US 60093 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-01-22 |