12CC SALINE SYRINGE (10CC) 8881570121

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a other,user facility report with the FDA on 2020-02-27 for 12CC SALINE SYRINGE (10CC) 8881570121 manufactured by Covidien.

Event Text Entries

[181802991] The incident sample has been requested but to date has not been received for evaluation. If the sample is received, or if additional information pertinent to the incident is obtained a follow-up report will be submitted. As part of our manufacturing process, all device history records are reviewed and approved by quality, prior to release of product.
Patient Sequence No: 1, Text Type: N, H10


[181802992] The customer reported that the syringe had negative pressure which draws the fluid back into the syringe. The nurse flushed the extension tubing only to find that the fluid she previously placed into the j loop withdrew into the syringe, therefore the extension tubing was filled with air.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1017768-2020-00806
MDR Report Key9766026
Report SourceOTHER,USER FACILITY
Date Received2020-02-27
Date of Report2020-03-06
Date of Event2020-01-23
Date Mfgr Received2020-02-19
Date Added to Maude2020-02-27
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactJILL SARAIVA
Manufacturer Street15 HAMPSHIRE STREET
Manufacturer CityMANSFIELD MA 02048
Manufacturer CountryUS
Manufacturer Postal02048
Manufacturer Phone5086183640
Manufacturer G1COVIDIEN
Manufacturer Street2010 EAST INTERNATIONAL SPEEDW
Manufacturer CityDELAND FL 32724
Manufacturer CountryUS
Manufacturer Postal Code32724
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand Name12CC SALINE SYRINGE (10CC)
Generic NameSALINE, VASCULAR ACCESS FLUSH
Product CodeNGT
Date Received2020-02-27
Model Number8881570121
Catalog Number8881570121
Lot Number19F0734
Device AvailabilityY
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerCOVIDIEN
Manufacturer Address2010 EAST INTERNATIONAL SPEEDW DELAND FL 32724 US 32724


Patients

Patient NumberTreatmentOutcomeDate
10 2020-02-27

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