MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2019-08-27 for NDEHP SAPPHIRE YLW STRIPED+PAV 1637402 163740455 manufactured by Icu Medical Costa Rica Ltd..
| Report Number | 9615050-2019-00364 |
| MDR Report Key | 8935301 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2019-08-27 |
| Date of Report | 2019-08-08 |
| Date of Event | 2019-07-28 |
| Date Mfgr Received | 2019-09-20 |
| Device Manufacturer Date | 2018-10-01 |
| Date Added to Maude | 2019-08-27 |
| 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 |
| Reporter Occupation | OTHER HEALTH CARE PROFESSIONAL |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | CHRISTOPHER ZANONI |
| Manufacturer Street | 600 N. FIELD DR. |
| Manufacturer City | LAKE FOREST IL 60045 |
| Manufacturer Country | US |
| Manufacturer Postal | 60045 |
| Manufacturer Phone | 2247062300 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | NDEHP SAPPHIRE YLW STRIPED+PAV |
| Generic Name | ELECTRIC INFUSION PUMP ADMINISTRATION SET, SINGLE-USE |
| Product Code | MRZ |
| Date Received | 2019-08-27 |
| Model Number | 1637402 |
| Catalog Number | 163740455 |
| Lot Number | 946365H |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ICU MEDICAL COSTA RICA LTD. |
| Manufacturer Address | ZONA FRANCA GLOBAL LA AURORA HEREDIA CS |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-08-27 |