BEUDAMED
    FDA Adverse Event Summary report: N

    HUBER NEEDLE, 90 DEGREES, 20 GA, 3/4 INCH

    MDR report key: 11382 · Received February 8, 1994

    Report

    Report Number
    MW1000679
    Date Received
    February 8, 1994
    Date of Event
    January 26, 1994
    Report Date
    January 27, 1994
    Manufacturer
    MSM, INC.
    Product Code
    FOZ
    Report Source
    Voluntary report
    Reporter Location
    FL, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    THE PT HAS A PORT ACCESSED WITH A NEEDLE WITH EXTENSION TO ADMINISTER PRN ANTIEMETIC. THE HUSBAND NOTED A BLOOD SATURATED DRESSING ON THE PORT SITE. THE PT COMPLAINED OF CHEST PAIN UPON INSPIRATION. THE HUSBAND REMOVED THE DRESSING AND NOTED ON EXPIRATION, BLOOD WAS COMING OUT OF THE NEEDLE. HE REMOVED THE NEEDLE, AND CALLED 911 AND DR. PT WAS ACCESSED IN THE ER. THE PLASTIC HOUSING AND BUTTERFLY WINGS HAD DISLODGED FROM THE METAL NEEDLE, LEAVING THE NEEDLE IN THE PORT. (*)

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HUBER NEEDLE, 90 DEGREES, 20 GA, 3/4 INCH FOZ MSM, INC. 2H002M

    Patients

    Seq Age Sex Outcome Treatment
    1 *