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 2019-12-11 for CLEARLINK BLOOD RECIPIENT SET FNC1173 manufactured by Baxter Healthcare Corporation.
[170435793]
(b)(6). Should additional relevant information become available, a supplemental report will be submitted.
Patient Sequence No: 1, Text Type: N, H10
[170435834]
It was reported that a? Piece of the tubing? Attached to the top of the filter chamber of a clearlink blood recipient set disconnected resulting in a loss of a portion of the blood this occurred during use on a patient in the general patient ward. There was no patient injury or medical intervention associated with this event. No additional information is available.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1416980-2019-06841 |
| MDR Report Key | 9453727 |
| Report Source | COMPANY REPRESENTATIVE,HEALTH |
| Date Received | 2019-12-11 |
| Date of Report | 2020-02-25 |
| Date of Event | 2019-10-21 |
| Date Mfgr Received | 2020-02-10 |
| Date Added to Maude | 2019-12-11 |
| 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 | BIOMEDICAL ENGINEER |
| 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 - SINGAPORE |
| Manufacturer Street | 2 WOODLANDS INDUSTRIAL PARK D |
| Manufacturer City | SINGAPORE 738750 |
| Manufacturer Country | SN |
| Manufacturer Postal Code | 738750 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | CLEARLINK BLOOD RECIPIENT SET |
| Generic Name | SET, BLOOD TRANSFUSION |
| Product Code | BRZ |
| Date Received | 2019-12-11 |
| Model Number | NA |
| Catalog Number | FNC1173 |
| Lot Number | NI |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BAXTER HEALTHCARE CORPORATION |
| Manufacturer Address | DEERFIELD IL |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-12-11 |