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MAUDE Adverse Event Report: HALYARD ECLIPSE HOMEPUMP
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HALYARD ECLIPSE HOMEPUMP
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Model Number
E102000
Device Problem
Hole In Material (1293)
Patient Problem
No Known Impact Or Consequence To Patient (2692)
Event Date
01/29/2018
Event Type
malfunction
Event Description
Eclipse homepump (model # 102000, lot # 0202801727) containing invanz 1 gram in 0.9 percent sodium chloride 100 ml had a hole in it.
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Brand Name
ECLIPSE HOMEPUMP
Type of Device
ECLIPSE HOMEPUMP
Manufacturer
(Section D)
HALYARD
alpharetta GA 30004
MDR Report Key
7233692
MDR Text Key
98850555
Report Number
MW5074997
Device Sequence Number
1
Product Code
MEB
Combination Product (y/n)
N
Reporter Country Code
US
Number of Events Reported
1
Summary Report (Y/N)
N
Report Source
Voluntary
Reporter Occupation
Pharmacist
Type of Report
Initial
Report Date
01/30/2018
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 Model Number
E102000
Device Lot Number
0202801727
Was Device Available for Evaluation?
Device Returned to Manufacturer
Is the Reporter a Health Professional?
Yes
Initial Date Manufacturer Received
Not provided
Initial Date FDA Received
01/31/2018
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
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