FDA Adverse Event Injury Summary report: N

FLOQSWAB

MDR report key: 10934507 · Received December 2, 2020

Report

Report Number
3002444944-2020-00012
Event Type
Injury
Date Received
December 2, 2020
Date of Event
October 16, 2020
Report Date
November 4, 2020
Manufacturer
COPAN ITALIA SPA
Product Code
KXG
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
US
Reporter Occupation
OTHER

Narratives

Description of Event or Problem · 1

A REPORT WAS SENT BY THE INITIAL REPORTER TO FDA THROUGH THE MEDWATCH PROGRAM (REPORT#MW5097371). COPAN DIAGNOSTICS, AS COPAN (B)(4) US AGENT, BECAME AWARE OF THE EVENT ON (B)(6) 2020. THE REPORT WAS RECEVIED IN THE MAILBOX AS FIRST AND SOLE NOTIFICATION OF THE EVENT. THE DESCRIPTION OF THE EVENT WAS AS FOLLOWS: "COVID SWAB TEST PERFORMED. PT EXPERIENCED HEADACHE, TRACE BLEEDING AND TEARING OF THE EYES. PT ALSO COMPLAINED THAT SHE "FELT SOMETHING IN HER NOSE". LATER THAT DAY PT HAD RINGING IN HER EARS. PT ALSO NOTED THAT AFTER 4 DAYS FOLLOWING THE TEST HER LEFT NOSTRIL "STILL HURTS". THE FLOQSWABS COPAN FLOCKED WAS USED. LOT # 192020, EXP 05/2024. FDA SAFETY REPORT ID # (B)(4)". ON THE MEDWATCH PROGRAM THE LOT# REPORTED WAS 1920240 OF CAT. # 503CS01.BD10. SINCE NO EMAIL OR PHONE CONTACT WAS REPORTED IN MEDWATCH, ON NOVEMBER 9TH, 2020 COPAN CONTACTED THE DISTRIBUTOR OF CAT. # TO ASK ADDITIONAL INFORMATION AND TO CONFIRM THE LOT #, SINCE IN MEDWATCH DESCRIPTION WAS REPORTED 192020 AND IN LOT FIELD 1920240. ON NOVEMBER 13TH, 2020 COPAN CONTACTED THE DISTRIBUTOR ASKING TO RETRIEVE INFORMATION OF THE INITIAL REPORTER AND SENDING A QUESTIONNAIRE TO FURTHER INVESTIGATE THE EVENT WITH THE INITIAL REPORTER. COPAN MADE 3 ADDITIONAL ATTEMPTS WITH DISTRIBUTOR TO OBTAIN MISSING INFORMATION (ON THE 16TH NOV, 18TH NOV AND 24TH NOV). NO ADDITIONAL INFORMATION WAS RECEIVED TILL NOW.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1398388 FLOQSWAB FLOQSWABS KXG COPAN ITALIA SPA 503CS01.BD10 1920240

Patients

Seq Age Sex Outcome Treatment
1