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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: QUICK-SET®; QUICK-SET 110/6
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QUICK-SET®; QUICK-SET 110/6 Back to Search Results
Lot Number 5115706
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
(b)(4).Event occurred in (b)(6).It was reported that the infusion set's tubing had detached at the quick release and this issue occurred with ten sets.No further information available.
 
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Brand Name
QUICK-SET®
Common Device Name
QUICK-SET 110/6
MDR Report Key8763170
Report Number3003442380-2019-01602
Device Sequence Number2473530
Product Code FPA
UDI-Device Identifier05705244006638
UDI-Public05705244006638
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 Date12/15/2018
Device Lot Number5115706
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 01/31/2017
Initial Report FDA Received Date07/05/2019
Patient Sequence Number1
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