MAUDE Adverse Event Report: BAXTER HEALTHCARE CORPORATION EXACTA MIX 500 ML; SET, I.V. FLUID TRANSFER

Model Number H938738

Device Problem Leak/Splash (1354)

Patient Problem No Information (3190)

Event Date 11/08/2018

Event Type  malfunction  

Event Description

Exactamix 500 ml leak at the center port discovered during compound.

• Brand Name: EXACTA MIX 500 ML
• Type of Device: SET, I.V. FLUID TRANSFER
• Manufacturer (Section D): BAXTER HEALTHCARE CORPORATION
• MDR Report Key: 8199734
• MDR Text Key: 131896955
• Report Number: MW5082628
• Device Sequence Number: 1
• Product Code: LHI
• Combination Product (y/n): N
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Voluntary
• Reporter Occupation: Pharmacist
• Type of Report: Initial
• Report Date: 12/20/2018

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Expiration Date: 04/30/2021
• Device Model Number: H938738
• Device Lot Number: 60124657
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Initial Date Manufacturer Received: Not provided
• Initial Date FDA Received: 12/26/2018
• Was Device Evaluated by Manufacturer?: No Information
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: N
• Patient Sequence Number: 1