INTRAVIA CONTAINER EMPTY 2B8013

MAUDE Adverse Event Report

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 2020-03-20 for INTRAVIA CONTAINER EMPTY 2B8013 manufactured by Baxter Healthcare Corporation.

Event Text Entries

[184348815] Date of the event was reported as an unknown date in (b)(6) 2020 (also reported as "this week"). Should additional relevant information become available, a supplemental report will be submitted.
Patient Sequence No: 1, Text Type: N, H10


[184348816] It was reported particulate was observed in an intravia container. The particulate was described as plastic pieces? Floating around in bags?. During compounding, the set is used in conjunction with the baxter repeater pump and non-baxter needle free valve. The device is filled with unknown medicated solution (example of the complaint stated milrinone and dextrose). There was no patient involvement. No additional information is available.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1416980-2020-01602
MDR Report Key9862360
Report SourceCOMPANY REPRESENTATIVE,HEALTH
Date Received2020-03-20
Date of Report2020-03-20
Date Mfgr Received2020-02-25
Date Added to Maude2020-03-20
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationOTHER HEALTH CARE PROFESSIONAL
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer Street25212 W. ILLINOIS ROUTE 120
Manufacturer CityROUND LAKE IL 60073
Manufacturer CountryUS
Manufacturer Postal60073
Manufacturer Phone2242702068
Manufacturer G1BAXTER HEALTHCARE - DOMINICAN REPUBLIC
Manufacturer StreetCARRETERA SANCHEZ KM 18.5 PARQUE INDUSTRIAL ITABO, PIISA
Manufacturer CityHAINA, SAN CRISTOBAL
Manufacturer CountryDR
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameINTRAVIA CONTAINER EMPTY
Generic NameCONTAINER, I.V
Product CodeKPE
Date Received2020-03-20
Model NumberNA
Catalog Number2B8013
Lot NumberDR19E21046
Device AvailabilityN
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerBAXTER HEALTHCARE CORPORATION
Manufacturer AddressDEERFIELD IL


Patients

Patient NumberTreatmentOutcomeDate
10 2020-03-20

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