DRAINS ACCESSORIES 19927

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor,foreign,health pr report with the FDA on 2020-03-30 for DRAINS ACCESSORIES 19927 manufactured by Atrium Medical Corporation.

Event Text Entries

[186269731] A follow up report will be submitted upon completion of the investigation into this event.
Patient Sequence No: 1, Text Type: N, H10


[186269732] Nighttime bedside respiratory therapist performing standard tissue plasminogen activator administration as per protocol. While flushing the tissue plasminogen activator, the luer-lock connector became disconnected at the flexible tubing, leaving system open to patient. Frontline staff re-inserted the connector, and taped to secure. Daytime respiratory therapist, switched out device.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number3011175548-2020-00483
MDR Report Key9901127
Report SourceDISTRIBUTOR,FOREIGN,HEALTH PR
Date Received2020-03-30
Date of Report2020-03-30
Date Mfgr Received2020-03-25
Date Added to Maude2020-03-30
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 Street40 CONTINENTAL BLVD
Manufacturer CityMERRIMACK NH 03054
Manufacturer CountryUS
Manufacturer Postal03054
Manufacturer G1ATRIUM MEDICAL CORPORATION
Manufacturer Street40 CONTINENTAL BLVD
Manufacturer CityMERRIMACK NH 03054
Manufacturer CountryUS
Manufacturer Postal Code03054
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameDRAINS ACCESSORIES
Generic NameBOTTLE, COLLECTION, VACUUM
Product CodeKDQ
Date Received2020-03-30
Model Number19927
Catalog Number19927
OperatorHEALTH PROFESSIONAL
Device Availability*
Device Eval'ed by Mfgr*
Device Sequence No1
Device Event Key0
ManufacturerATRIUM MEDICAL CORPORATION
Manufacturer Address40 CONTINENTAL BLVD MERRIMACK NH 03054 US 03054


Patients

Patient NumberTreatmentOutcomeDate
101. Required No Informationntervention 2020-03-30

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