FDA Adverse Event Summary report: N

SAF-T-INTIMA SHIELDED IV CATHETER

MDR report key: 1012361 · Received March 10, 2008

Report

Report Number
9610847-2008-00021
Date Received
March 10, 2008
Report Date
March 5, 2008
Manufacturer
BECTON DICKINSON INFUSION THERAPY SYSTEMS
Product Code
FOZ
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
UK
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

ATTEMPTS HAVE BEEN MADE TO OBTAIN ADDITIONAL INFO. UPON CO COMPLETION OF THE INVESTIGATION, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

Description of Event or Problem · 1

THE PRN LOOSENED FROM THE SAF-T-INTIMA DEVICE AND REMAINED ATTACHED TO THE TELESCOPING SHIELD DURING THE NEEDLE REMOVAL; THIS WENT UNNOTICED UNTIL THE NEXT NURSE VISIT. MEDICATION HAD LEAKED OUT OF THE ADMINISTRATION SET. THE DEVICE WAS IN USE BY A TERMINALLY ILL PATIENT AT HOME. THE PT WAS UNHARMED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 SAF-T-INTIMA SHIELDED IV CATHETER INTRAVASCULAR CATHETER FOZ BECTON DICKINSON INFUSION THERAPY SYSTEMS NA UNK

Patients

Seq Age Sex Outcome Treatment
1 UNK