MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-09-23 for 81 CM (32") APPX 5.1 ML, 20 DROP BLOOD SET W/200 MICRON FILTER, ROTATING LUER, B 011-C6028 manufactured by Icu Medical De Mexico, S. De R.l. De C.v..
| Report Number | 9617594-2019-00312 |
| MDR Report Key | 9106674 |
| Date Received | 2019-09-23 |
| Date of Report | 2019-09-06 |
| Date of Event | 2019-09-01 |
| Date Mfgr Received | 2019-10-17 |
| Device Manufacturer Date | 2019-04-01 |
| Date Added to Maude | 2019-09-23 |
| 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 | 81 CM (32") APPX 5.1 ML, 20 DROP BLOOD SET W/200 MICRON FILTER, ROTATING LUER, B |
| Generic Name | SET, TUBING, BLOOD, WITH AND WITHOUT ANTI-REGURGITATION VALVE |
| Product Code | FJK |
| Date Received | 2019-09-23 |
| Catalog Number | 011-C6028 |
| Lot Number | 4040339 |
| 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 DE MEXICO, S. DE R.L. DE C.V. |
| Manufacturer Address | AVENIDA CUARZO NO. 250 ENSENADA, B.CFA. 22790 MX 22790 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-09-23 |