WINGED INFUSION SET 20G X 1 IN N/A 0604200

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a other report with the FDA on 2020-03-26 for WINGED INFUSION SET 20G X 1 IN N/A 0604200 manufactured by Bard Access Systems.

MAUDE Entry Details

Report Number3006260740-2020-01083
MDR Report Key9885355
Report SourceOTHER
Date Received2020-03-26
Date of Report2020-03-26
Date of Event2020-02-13
Date Mfgr Received2020-03-10
Date Added to Maude2020-03-26
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 ContactKELSEY ERICKSON
Manufacturer Street605 N. 5600 W.
Manufacturer CitySALT LAKE CITY UT 84116
Manufacturer CountryUS
Manufacturer Postal84116
Manufacturer Phone8015225937
Manufacturer G1BARD REYNOSA S.A. DE C.V. -9617592
Manufacturer StreetBLVD. MONTEBELLO #1 PARQUE INDUSTRIAL COLONIAL
Manufacturer CityREYNOSA, TAMAULIPAS
Manufacturer CountryMX
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameWINGED INFUSION SET 20G X 1 IN
Generic NameNEEDLE, HYPODERMIC, SINGLE LUMEN
Product CodeFMI
Date Received2020-03-26
Model NumberN/A
Catalog Number0604200
Lot NumberUNK
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerBARD ACCESS SYSTEMS
Manufacturer Address605 N. 5600 W. SALT LAKE CITY UT 84116 US 84116


Patients

Patient NumberTreatmentOutcomeDate
10 2020-03-26

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