Sequence Number||','|| Treatment -- multiple source type, separate by ';'
FUJINON ENDOSCOPE (UNKNOWN MODEL NUMBER)
DIANEAL 1.36%, DIANEAL 2.27%, HOMECHOICE
DIANEAL 1.5% SINGLEBAG, DIANEAL 2.5% SINGLEBAG
CARTRIDGE MODEL- AQ CARTRIDGE-FP - LOT NUMBER-UNK
HEARTMATE II SYSTEM CONTROLLER S/N (B)(4)
DIANEAL PD4 1.5% 2L, DIANEAL PD4 2.5% 2L
SMITH MEDICAL TRACHEOSTOMY TUBETRI-ANIM RESUSCIT
OLYMPUS GASTROSCOPE (UNKNOWN MODEL NUMBER)
OLYMPUS ENDOSCOPE (UNKNOWN MODEL NUMBER)
N/A-INCIDENT HAPPENED BEFORE REACHING THE PATIENT.
PRI TUBING,8100, THERAPY DATE (B)(6) 2015
MITRACLIP SYSTEM, STEERABLE GUIDE CATHETER
AQ CARTRIDGE FP MODEL, LOT NUMBER UNKNOWN
DIANEAL PD-2 1.5%, DIANEAL PD-2 2.5%, EXTRANEAL,
8100,8015,PRI TUBING, THERAPY DATE (B)(6)
DIANEAL PD-2 1.5%, DIANEAL PD-2 2.5%, EXTRANEAL
DIANEAL 1.5% AND 2.5% LOW CALCIUM SINGLEBAG
DIANEAL 2.5% SINGLEBAG (LOW CALCIUM), EXTRANEAL
1.5% AND 2.5% DIANEAL PD4 ULTRABAG THERAPIES
2AF281 ARCTIC FRONT CARDIAC CRYOABLATION CATHETER
AR-9503L-06C, HUMERAL INSERT, LOT 2501375203
NO - THIS DEVICE WAS NOT USED ON THE PATIENT, DEFE
FIRST GENERATOR SN# (B)(4), SECOND GENERATOR S
NO OTHER DEVICES RELEVANT TO DEVICE FAILURE
DIANEAL 1.5% AND 2.5% AND 4.25% PD4 ULTRASOUND
JOHNSON & JOHNSON/ETHICON GYNEMESH PS: 2005
JOHNSON & JOHNSON/ETHICON SECUR: (B)(6) 2007
EXTRANEAL, PHYSIONEAL 2.5%, NUTRINEAL PD-4
DIANEAL 1.5% SINGLEBAG AND 2.5% ULTRABAG
8015,EXT TUBING, THERAPY DATE (B)(6) 2015
MICROBORE NON-DEHP CATHETER EXTENSION SET
NOTHING THAT CAUSED OR CONTRIBUTED TO THE EVENT
ANTERIOR CERVICAL PLATE AND CERVICAL SCREWS.
VALVCYCLOVIR, LITHIUM, TOPIRIMATE, PROZAC, ABILIFY
DIANEAL LOW CALCIUM 1.5% DEXTROSE (2 LITER)
DIANEAL 1.5% LOW CALCIUM SINGLEBAG, EXTRANEAL
A1072 MAYFIELD DISPOSABLE ADULT SKULL PINS
SPECTRANETICS CVX-300 EXCIMER LASER SYSTEM
NO OTHER DEVICES WERE IN USE THAT MAY HAVE CAUSED
IDRIVE ULTRA POWERED HANDLE 1 SERIAL (B)(4)
4000 MG OF FLUOROURACIL DILUTED WITH 0.9% NACL
LOW CALCIUM (LACTATE G1.5% AND G2.5%) SOLUTION
DIANEAL 1.5% AMBUFLEX, DIANEAL 2.5% AMBUFLEX
HM POWER MODULE 14V PT CABLE LOT #35361350414
DIANEAL 1.5% ULTRABAG, DIANEAL 2.5% ULTRABAG
NON-CFN CATHETER, THERAPY DATE (B)(6) 2015
P/N 1110380: IS DISPOSABLE CIRCUIT ACTIVE WT
MORPHINE IN GLUCOSALINE, SUBCUTANEOUS CATHETER
STEERABLE GUIDE CATHETER, IMPLANTED MITRACLIP (X1)
PD4 BAXTER DIANEAL LOW CALCIUM 1.5% DEXTROSE
1.5%, 2.5% AND 4.25% DIANEAL LOW CALCIUM THERAPIES
EXTRANEAL, PHYSIONEAL 1.5%, NUTRINEAL PD4 SOLUTION
DIANEAL PD2 1.5% AND DIANEAL PD2 2.5% SINGLEBAG
PHYSIONEAL 40 2.27% ,EXTRANEAL, UV FLASH
PHYSIONEAL 40 1.36%, PHYSIONEAL 40 2.27%
RADIO FREQUENCY CONTROLLER - SERIAL NUMBER UNK
DIANEAL 1.5%, DIANEAL 2.5% AND EXTRANEAL 7.5%
BOSTON SCIENTIFIC GASTROSCOPY BIOPSY FORCEPS
HEMI HEAD, PART # 74122538, LOT # UNKNOWN
DIANEAL 2.5% AMBUFLEX, DIANEAL PD4 2.5% ULTRABAG
REFER TO THE ATTACHMENT TO THE MEDWATCH.
I'M HAVING TO TAKE NORCO AND MOTRIN 800 DUE TO PAI
PHYSIONEAL 1,36 %, CYCLER DRAINAGE SET, CASSETTE
DEXCOM G4 PLATINUM CONTINUOUS MONITORING SYSTEM
DIANEAL PD4 1.5%, DIANEAL PD4 2.5% SOLUTIONS
HOMECHOICE, DIANEAL PD4 2.5% SINGLEBAG SOLUTIONS
DIANEAL 1.5% LOW CALCIUM PD4, EXTRANEAL 7.5%
ACETABULAR CUP, # 74120148, LOT # UNKNOWN
PLUM A+ SOFTWARE MODULE, LIST #12097, SN (B)(4)
OSCILLATOR MALFUNCTION AND WAS NOT HOLDING PRESSUR
MIRENA (LEVONORGESTREL) INTRAUTERINE DELIVERY SYST
DIANEAL 1.5% AND 2.5% LOW CALCIUM ULTRABAG
THIS PATIENT HAD COMPLEX MEDICAL HISTORY. FLUID SH
ANSPACH X-MAX DRILL IN USE FOR CRANIOTOMY - CRANI-
INJECTOR MODE L- MSI-TM - LOT NUMBER - UNK
INTRODUCER SHEATH: 5FR ULTRA HIGH FLOW SHEATH
NO OTHER MEDICINES AT THE ONSET OF SIDE EFFECTS
CORIN CORMET CUP PEGLESS, (B)(4). LOT: KGKU
CORIN CORMET CUP PEGLESS, REF: (B)(4), LOT: JYNJ
DIANEAL 2.5% PD-2 5, EXTRANEAL, HOMECHOICE
DIANEAL PD4, 2.5% ULTRABAG AND EXTRANEAL
PHYSIONEAL 2.5% 2L AND PHYSIONEAL 1.5% 2L
DIANEAL AMBUFLEX PD4 1.5%, EXTRANEAL, HOMECHOICE
DIANEAL LOW CA 1.5%, DIANEAL LOW CA 2.5%
DIANEAL 2.5% LOW CALCIUM ULTRABAG, EXTRANEAL 7.5%
HANDLE "HIQ+", ERGO S, UNIPOLAR (A60201A)
EXTRANEAL, PHYSIONEAL 1.5%, PHYSIONEAL 2.5%
DIANEAL 2.5% SINGLEBAG, DIANEAL 4.25% SINGLEBAG
DIANEAL PD4 2.5% AND EXTRANEAL SOLUTIONS
DIANEAL PD4 1.5% AND 2.5% ULTRABAG SOLUTIONS
AR-8724L-20, LOW PROFILE SCREW, LOT 137475.
CARPAL POLY COMPONENT : 26-2300 / LOT FX0104
DIOVAN, AMBIEN, POTASSIUM ACETATE, PROCARDIA
DIANEAL 1.5%, 2.5%, 4.25% LOW CALCIUM SINGLEBAG
DIANEAL 2.5% LOW CALCIUM ULTRABAG, HOMECHOICE
DIANEAL 2.5% PD4 AMBUFLEX, DIANEAL 2.5% ULTRABAG
HOMECHOICE, DIANEAL AND EXTRANEAL SOLUTIONS
300 MG OF MORPHINE AND 700 MG OF KETOPROFENE
EUROCONE CORMET MODULAR, REF: E079.852, LOT: HLTJ
EUROCONE CORMET MODULAR REF. E079.752 LO. HQMK
ACETABULAR SHELL, # 71331952, LOT # UNKNOWN
GUIDE WIRE: 014X175 ASTATO XS (ASAHI INTECC)
SHEATH: 6F, 10FHEPARIN, CLOPIDOGREL, ASPIRIN
SHARP CRAMPS IN THE OVARY AREA, BLOATING
NO - NOT PATIENT RELATED - WALL MOUNTED SHARPS CON
BYSTOLIC, ZESTRIL, FIORNAL WITH CODEINE, LIPITOR
1.5% AND 2.5% DIANEAL PD4 AMBUFLEX THERAPY
LOW CALCIUM PERITONEAL DIALYSIS SOLUTION
ACETABULAR SHELL, # 71331954, LOT # UNKNOWN
DIANEAL 2.5% PD4 AMBUFLEX, EXTRANEAL, HOMECHOICE
GATEWAY BALLOON CATHETER (BOSTON SCIENTIFIC)
DIANEAL 1.5% ULTRABAG AND EXTRANEAL SOLUTIONS
RT-PLUS TIBIAL INSERT: 75005461, LOT D1022039
BALLOON CATHETER: 2X10MM TAZUNA/ 2.25MM NC TREK
DIANEAL 2.5% SINGLEBAG AND EXTRANEAL SOLUTIONS
DIANEAL PD4 1.5% AMBUFLEX AND HOMECHOICE
STENT: 3.0X18 MM CYPHER SELECT, 3.0X18 MM NORBI
VLOC 180 ESTITCH ABS 0 8 LOOP PRODUCT ID:VLOCA008
SAPPHIRE PUMP INFUSING MILRINONE 0.375MCG/KG/MIN -
PRIOR TO ESSURE INSERTION, I WAS ON THE DEPO SHOT.
DIANEAL 2.5%, 4.25% SINGLEBAG (LOW CALCIUM)
INFUSION PUMP, PARENTERAL NUTRITION SOLUTION
DIANEAL 1.5% AND 2.5% SINGLE BAG (LOW CALCIUM)
HOMECHOICE, DIANEAL PD2 1.5% AND EXTRANEAL
UNKNOWN MFGER. SYRINGE, DBLE LUMAN BROVIAC
8F, 14F, 21F SHEATHS, PROGLIDE (X2) HEPARIN
8F, 14F,21F SHEATHS, PROGLIDE (X2)HEPARIN
BENICAR, ESTROGEN, LIVIAL, PROGESTERONE, "LIVAIO"
FOAM TIP PLUNGER MODEL AND LOT NUMBER - UNK
AR-1360B, BIO-INTERF. SCREW, LOT UNKNOWN
DIANEAL 2.5% AND 4.25% SINGLEBAG PD2, HOMECHOICE
FIBRIN GLUE + 3/0 VICRYL SUTURE (B)(6) 2014
ROSUVASTATIN 40MG, ASPIRIN 100MG, CLOPIDOGREL 75MG
ESSURE WHICH WAS PLACED AROUND (B)(6) 2012
BLOATING, PELVIC PAIN, HEAVY BLEEDING, NICKEL ALLE
NONE REGULARLY.RX FOR ACUTE PROBLEMS (ANTIBIOTIC
OTHER, AT THE LAST OFFICE VISIT THEY WERE SEEN W
DIANEAL 1.5%, 2.5% LOW CALCIUM SINGLEBAGS
00-8801-001-00 AIR DERMATOME HANDPIECE (SN (B)(4))
DIANEAL 1.5% ULTRABAG, EXTRANEAL VIAFLEX
PLUM A+ SOFTWARE MODULE, LIST #UNK, SN (B)(4)
DIANEAL PD4 1,36%, DIANEAL PD4 2,27%, NUTRINEAL 21
LEXAPRO, LAMOTRIGINE, SIMVASTATIN, ARMOUR THYROID
G4 PLATINUM CONTINUOUS GLUCOSE MONITORING SYSTEM
TWO GATEWAY BALLOON CATHETERS (BOSTON SCIENTIFIC)
BIRTH CONTROL PILL USED AFTER,PRIOR TO CONFORMAT.
ANTIDEPRESSANTS HEART BURN MEDSBLOOD THINNERS
INJECTOR MODEL - NANOPOINT SYSTEM - LOT # 143401
LIPITOR, COUMADIN, ZOLOFT, WELLBUTRIN, LOVENOX
5MM XO BUTTON BRILL BIT, ITEM #C8590, LOT# UNKNOWN
BBRAUN SECONDARY LINE SET CONNECTED TO IT FOR IV M
I WAS NOT USING ANY MEDICAL PRODUCTS OR MEDICATION
CONSTANTLY BLEEDING,SYST OR MASS ON MY OVARIES, HA
I'M USING ESSURE FOR MORE THAN TWO YEARS AND THIS
OVER THE COUNTER PAIN KILLERS. IRON SUPPLEMENTS
WAS NOT USING ANY OTHER MEDICATION OR PRODUCTS.
COVIDIEN FORCETRIAD GENERATOR, UNKNOWN SERIAL #
COVIDIEN FORCETRIAD GENERATOR SERIAL # UNKNOWN
PULSE OX CONTINUOUS, HME, EXHALATION VALVE,NELLCOR
DIANEAL 1.5% AND 2.5% SINGLEBAG (LOW CALCIUM)
SEE H10 FOR CONCOMITANT MEDICAL PRODUCTS.
COMBINED PAK, 23 GAUGE, 5000 CUTS PER MINUTE
OTHER: MITRACLIP STEERABLE GUIDING CATHETER (SGC)
OTHER: MITRACLIP CLIP DELIVERY SYSTEM (CDS)
1.5%, 2.5%, AND 4.25% DIANEAL PD2 AMBUFLEX
DIANEAL 2.5% SINGLEBAG, DIANEAL 1.5% ULTRABAG
EXTRANEAL, PHYSIONEAL 1.5%, PHYSIONEAL 2.5%,
DIANEAL PD2 2.5% AND EXTRANEAL SOLUTIONS
(B)(4), BBRAUN SEC IV TUBING, TD (B)(6) 2015
(B)(4) ,BBRAUN SEC IV TUBING, TD (B)(6) 2015
ACTIVE FLUID MANAGEMENT SYSTEM PACK 0.9 MILLIMETER
OTHER: TWO MITRACLIPS, STEERABLE GUIDE CATHETER
DIANEAL 1.5% LOW CALCIUM, EXTRANEAL 7.5%
FILTER ON PATIENT SENSING LINE OF THE OSCILLATOR.
DIANEAL PD4, 1.5% & 2.5%, EXTRANEAL, PHYSIONEAL
PHACO UNIT SN, (B)(4), TIP MODEL: OPOR3019L
BALLOON CATHETER: 3.0X15 NC QUANTUM APEX
THE STIM PERFORMANCE SEEMED TO HAVE BEEN RELATED T
TRIPP LITE POWER MODULE (PART OF THE MOBILE MEDICA
ITEM FAILED DURING SETUP OF THE HEART LUNG BYPASS
DIANEAL 1.5% AND 2.5% SINGLEBAG, HOMECHOICE
DIANEAL PD4 AMBUFLEX, EXTRANEAL VIAFLEX,HOMECHOICE
DIANEAL 2.5% PD4 ULTRABAG, EXTRANEAL PD2
(B)(4) LONG STEM HEMIARTHROPLASTY PROSTHESI
6203-110-000, AO SMALL ATTACHMENT, LOT 14286
DIANEAL PD4 ULTRABAG 1.5%, DIANEAL PD4 ULTRABAG 2.
PHYSIONEAL 35 1.36%, EXTRANEAL, HOMECHOICE
(6F LONG SHEATH,TERUMO)401-611M BRITE TIP, CORDIS
SMITH&NEPHEW LONG STEM HEMIARTHROPLASTY PROSTHESIS
2.5% DIANEAL PD4 AMBUFLEX, 2.5% DIANEAL ULTRABAG
FLUOROURACIL DILUTED WITH 0.9% SODIUM CHLORIDE