MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2020-03-03 for SMALLBORE TRIFUSE EXT SET W/3REMV MICROCLAVE Z2914 manufactured by Icu Medical, Inc..
[181954254]
Nurse was setting up iv to use a trifuse extension set with microclave, but the port would not flush. In addition to this, even a second device with same concerns was reported.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9781712 |
| MDR Report Key | 9781712 |
| Date Received | 2020-03-03 |
| Date of Report | 2020-02-06 |
| Date of Event | 2019-12-27 |
| Report Date | 2020-02-06 |
| Date Reported to FDA | 2020-02-06 |
| Date Reported to Mfgr | 2020-03-03 |
| Date Added to Maude | 2020-03-03 |
| Event Key | 0 |
| Report Source Code | User Facility report |
| Manufacturer Link | N |
| 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 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | SMALLBORE TRIFUSE EXT SET W/3REMV MICROCLAVE |
| Generic Name | STOPCOCK, I.V. SET |
| Product Code | FMG |
| Date Received | 2020-03-03 |
| Catalog Number | Z2914 |
| Lot Number | 4388514 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ICU MEDICAL, INC. |
| Manufacturer Address | 951 CALLE AMANECER SAN CLEMENTE CA 92673 US 92673 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2020-03-03 |