MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,consum report with the FDA on 2019-08-26 for OUTLET PORT CLAMP 5C4527 manufactured by Baxter Healthcare - Swinford.
| Report Number | 1416980-2019-04630 |
| MDR Report Key | 8930571 |
| Report Source | COMPANY REPRESENTATIVE,CONSUM |
| Date Received | 2019-08-26 |
| Date of Report | 2019-08-26 |
| Date Mfgr Received | 2019-07-30 |
| Date Added to Maude | 2019-08-26 |
| 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 Street | 25212 W. ILLINOIS ROUTE 120 |
| Manufacturer City | ROUND LAKE IL 60073 |
| Manufacturer Country | US |
| Manufacturer Postal | 60073 |
| Manufacturer Phone | 2242702068 |
| Manufacturer G1 | BAXTER HEALTHCARE - SWINFORD |
| Manufacturer Street | FOXFORD ROAD |
| Manufacturer City | SWINFORD |
| Manufacturer Country | EI |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | OUTLET PORT CLAMP |
| Generic Name | CLAMP, LINE |
| Product Code | FKK |
| Date Received | 2019-08-26 |
| Model Number | NA |
| Catalog Number | 5C4527 |
| Lot Number | ASKU |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BAXTER HEALTHCARE - SWINFORD |
| Manufacturer Address | SWINFORD |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-08-26 |