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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: QUICK-SET®; QUICK-SET 60/6
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QUICK-SET®; QUICK-SET 60/6 Back to Search Results
Lot Number 5132367
Medical Device Problem Code Detachment of Device or Device Component (2907)
Health Effect - Clinical Code No Known Impact Or Consequence To Patient (2692)
Type of Reportable Event Malfunction
Event or Problem Description
Unomedical reference number (b)(4).Event occurred in (b)(6).The patient reported that the tubing detached near cannula side.No further information available.
 
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Brand Name
QUICK-SET®
Common Device Name
QUICK-SET 60/6
MDR Report Key8314354
Report Number3003442380-2019-00471
Device Sequence Number1663368
Product Code FPA
UDI-Device Identifier05705244006270
UDI-Public05705244006270
Combination Product (Y/N)N
PMA/510(K) Number
K991759
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source distributor
Initial Reporter Occupation Other
Type of Report Initial
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
Operator of Device No Information
Device Expiration Date01/15/2019
Device Lot Number5132367
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 04/03/2017
Initial Report FDA Received Date02/07/2019
Patient Sequence Number1
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