INTROCAN? N/A 4251717-01

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a foreign,health professional report with the FDA on 2019-10-29 for INTROCAN? N/A 4251717-01 manufactured by B. Braun Melsungen Ag.

MAUDE Entry Details

• Report Number: 9610825-2019-00512
• MDR Report Key: 9251415
• Report Source: FOREIGN,HEALTH PROFESSIONAL
• Date Received: 2019-10-29
• Date of Report: 2019-11-15
• Date of Event: 2019-09-17
• Date Mfgr Received: 2019-10-02
• Device Manufacturer Date: 2018-08-09
• Date Added to Maude: 2019-10-29
• 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: MR. JONATHAN SEVERINO
• Manufacturer Street: 861 MARCON BOULEVARD
• Manufacturer City: ALLENTOWN PA 18109
• Manufacturer Country: US
• Manufacturer Postal: 18109
• Manufacturer Phone: 4842408332
• Manufacturer G1: B. BRAUN MELSUNGEN AG
• Manufacturer Street: CARL-BRAUN-STR. 1
• Manufacturer City: MELSUNGEN, 34212
• Manufacturer Country: GM
• Manufacturer Postal Code: 34212
• Single Use: 3
• Previous Use Code: 3
• Event Type: 3
• Type of Report: 3

Device Details

• Brand Name: INTROCAN?
• Generic Name: I.V. SAFETY CATHETER
• Product Code: DQR
• Date Received: 2019-10-29
• Returned To Mfg: 2019-10-15
• Model Number: N/A
• Catalog Number: 4251717-01
• Lot Number: 18H09G8241
• Operator: HEALTH PROFESSIONAL
• Device Availability: R
• Device Age: DA
• Device Eval'ed by Mfgr: Y
• Device Sequence No: 1
• Device Event Key: 0
• Manufacturer: B. BRAUN MELSUNGEN AG
• Manufacturer Address: CARL-BRAUN-STR. 1 MELSUNGEN, 34212 GM 34212

Patients

Patient Number	Treatment	Outcome	Date
1	0		2019-10-29