MAUDE Adverse Event Report: C.R. BARD, INC. (BASD) -3006260740 SL CV FOR MAQUET IAB; STAND, INFUSION

Model Number N/A

Device Problem Defective Component (2292)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 07/19/2021

Event Type  malfunction  

Manufacturer Narrative

The manufacturer has received the sample and will evaluate.Results are expected soon.A lot history review (lhr) of jufq8517 showed two other similar product complaint(s) from this lot number.The complaints for this lot number (jufq8517) have been reported from the same facility.

Event Description

It was reported package found with the prep pad open.No other information was provided.It was reported this occurred on three devices.This report address the third device.

Event Description

It was reported package found with the prep pad open.No other information was provided.It was reported this occurred on three devices.This report address the third device.

Manufacturer Narrative

H11: section a through f - the information provided by bd represents all of the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bd.The device has not been returned to the manufacturer for evaluation.H3 other text : device not returned for evaluation.

• Brand Name: SL CV FOR MAQUET IAB
• Type of Device: STAND, INFUSION
• Manufacturer (Section D): C.R. BARD, INC. (BASD) -3006260740; 605 north 5600 west; salt lake city 84116
• MDR Report Key: 12320973
• MDR Text Key: 266584785
• Report Number: 3006260740-2021-03322
• Device Sequence Number: 1
• Product Code: FOX
• Combination Product (y/n): N
• PMA/PMN Number: EXEMPT
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: other,user facility
• Type of Report: Initial,Followup
• Report Date: 09/28/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 08/13/2021
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: N/A
• Device Catalogue Number: 0684000472
• Device Lot Number: JUFQ8517
• Was Device Available for Evaluation?: No
• Date Returned to Manufacturer: 07/25/2021
• Date Manufacturer Received: 09/22/2021
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Other