Brand Name | SOLUTION ADMINISTRATION SETS |
Type of Device | SET, ADMINISTRATION, INTRAVASCULAR |
Manufacturer (Section D) |
BAXTER HEALTHCARE - MALTA |
a47 industrial estate, malta b |
marsa |
MT |
|
Manufacturer (Section G) |
BAXTER HEALTHCARE - MALTA |
a47 industrial estate, malta b |
|
marsa |
MT
|
|
Manufacturer Contact |
kinga
almasan
|
25212 w. illinois route 120 |
round lake, IL 60073
|
2242702068
|
|
MDR Report Key | 5564333 |
MDR Text Key | 42223494 |
Report Number | 1416980-2016-06869 |
Device Sequence Number | 1 |
Product Code |
FPA
|
Combination Product (y/n) | N |
Reporter Country Code | SN |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,foreig |
Reporter Occupation |
Pharmacist
|
Type of Report
| Initial |
Report Date |
04/08/2016 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 04/08/2016 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Nurse
|
Device Expiration Date | 02/28/2020 |
Device Catalogue Number | VMC9627 |
Device Lot Number | 15C01V877 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Date Manufacturer Received | 03/15/2016 |
Date Device Manufactured | 04/27/2015 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Unknown
|
Patient Sequence Number | 1 |
Treatment | PACLITAXEL |
Patient Outcome(s) |
Required Intervention;
|
|
|