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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: INSET¿II; INSET II 60/9 BLUE
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INSET¿II; INSET II 60/9 BLUE Back to Search Results
Lot Number 5156976
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).It was reported that the tubing came off from the cannula and broke apart.No further information available.
 
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Brand Name
INSET¿II
Common Device Name
INSET II 60/9 BLUE
MDR Report Key8461038
Report Number3003442380-2019-00700
Device Sequence Number14197636
Product Code FPA
UDI-Device Identifier05705244007451
UDI-Public05705244007451
Combination Product (Y/N)N
PMA/510(K) Number
K032854
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 Date08/15/2019
Device Lot Number5156976
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 06/12/2017
Initial Report FDA Received Date03/28/2019
Patient Sequence Number1
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