BEUDAMED
    FDA Adverse Event Other Summary report: N

    VACUTAINER 21G X 1 OR 22 G X 1

    MDR report key: 13937 · Received April 12, 1994

    Report

    Report Number
    13937
    Event Type
    Other
    Date Received
    April 12, 1994
    Date of Event
    January 28, 1994
    Report Date
    March 16, 1994
    Manufacturer
    BECTON DICKINSON AND CO.
    Product Code
    JKA
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    IA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PT HAD A VENIPUNCTURE DONE IN THE LEFT ANTECUBITAL FOSSA. SUFFERED IMMEDIATE SHOOTING PAIN DOWN THE ARM AND INTO THE HAND AND THUMB. CONTINUES TO HAVE PAIN AND HAS DIFFICULTY WRITING AT WORK.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 VACUTAINER 21G X 1 OR 22 G X 1 MULTIPLE SAMPLE NEEDLES JKA BECTON DICKINSON AND CO. UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 32 YR Other