AC PUMP POWER CORD CSA GREY 400100678

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2019-10-09 for AC PUMP POWER CORD CSA GREY 400100678 manufactured by Baxter Healthcare - Englewood.

MAUDE Entry Details

Report Number1416980-2019-05496
MDR Report Key9173280
Report SourceCOMPANY REPRESENTATIVE,HEALTH
Date Received2019-10-09
Date of Report2019-10-09
Date of Event2019-09-13
Date Mfgr Received2019-09-13
Date Added to Maude2019-10-09
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationPHARMACIST
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer Street25212 W. ILLINOIS ROUTE 120
Manufacturer CityROUND LAKE IL 60073
Manufacturer CountryUS
Manufacturer Postal60073
Manufacturer Phone2242702068
Manufacturer G1BAXTER HEALTHCARE - ENGLEWOOD
Manufacturer Street14445 GRASSLANDS DR
Manufacturer CityENGLEWOOD CO 80112
Manufacturer CountryUS
Manufacturer Postal Code80112
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameAC PUMP POWER CORD CSA GREY
Generic NameSYSTEM/DEVICE, PHARMACY COMPOUNDING
Product CodeNEP
Date Received2019-10-09
Model NumberNA
Catalog Number400100678
Lot NumberNA
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerBAXTER HEALTHCARE - ENGLEWOOD
Manufacturer AddressENGLEWOOD CO


Patients

Patient NumberTreatmentOutcomeDate
10 2019-10-09

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