BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CENTURION KLEEN NEEDLE HEPLOCK

    MDR report key: 14587 · Received July 8, 1994

    Report

    Report Number
    MW1002757
    Event Type
    Injury
    Date Received
    July 8, 1994
    Date of Event
    June 23, 1994
    Report Date
    June 27, 1994
    Manufacturer
    TRI-STATE HOSPITAL SUPPLY CORP.
    Product Code
    FOZ
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    DEFECTIVE COMPONENT. PT PHONED TO REPORT INABILITY TO CONNECT REPLACEMENT HEPARIN LOCK CAP TO EXISTING CENTRAL LINE. NURSING VISIT OBSERVATION REVEALED FRACTURED/SHEARED INNER CANNULA FROM HEPARIN LOCK, TO BE THREADED/RECESSED INTO LUMEN CONNECTOR OF CENTRAL LINE. PT RECEIVING DAILY/CYCLICAL 3-1 TPN. REQUIRED INTERVENTION TO PREVENT PERMANENT IMPAIRMENT OR DAMAGE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CENTURION KLEEN NEEDLE HEPLOCK HEPARIN LOCK CAP FOZ TRI-STATE HOSPITAL SUPPLY CORP. 10132, 1105, 07272 OR 05202

    Patients

    Seq Age Sex Outcome Treatment
    1 56 YR Other| R GROSHONG CATHTER FOR CVA