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 2020-03-02 for CXI SUPPORT CATHETER G52543 CXI-4.0-35-135-P-NS-DAV manufactured by Cook Inc.
[182928399]
Occupation = non-healthcare professional. Pma/510(k) number = k160884. This report includes information known at this time. A follow-up report will be submitted should additional relevant information become available.
Patient Sequence No: 1, Text Type: N, H10
[182928400]
As reported, during an unknown procedure, a cxi support catheter hub separated from the device. Additional information regarding event details, patient anatomy and outcome has been requested, but is not available at this time.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1820334-2020-00521 |
| MDR Report Key | 9774607 |
| Report Source | COMPANY REPRESENTATIVE,HEALTH |
| Date Received | 2020-03-02 |
| Date of Report | 2020-03-05 |
| Date of Event | 2020-02-19 |
| Date Mfgr Received | 2020-02-25 |
| Device Manufacturer Date | 2019-08-07 |
| Date Added to Maude | 2020-03-02 |
| 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 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MRS. JENNIFER CANADA |
| Manufacturer Street | 750 DANIELS WAY |
| Manufacturer City | BLOOMINGTON IN 47404 |
| Manufacturer Country | US |
| Manufacturer Postal | 47404 |
| Manufacturer Phone | 8123392235 |
| Manufacturer G1 | COOK INC |
| Manufacturer Street | 750 DANIELS WAY |
| Manufacturer City | BLOOMINGTON IN 47404 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 47404 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | CXI SUPPORT CATHETER |
| Generic Name | KRA CATHETER, CONTINUOUS FLUSH |
| Product Code | KRA |
| Date Received | 2020-03-02 |
| Returned To Mfg | 2020-03-02 |
| Model Number | G52543 |
| Catalog Number | CXI-4.0-35-135-P-NS-DAV |
| Lot Number | 9933716 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | COOK INC |
| Manufacturer Address | 750 DANIELS WAY BLOOMINGTON IN 47404 US 47404 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2020-03-02 |