BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DRAIN TOW JP

    MDR report key: 1477459 · Received September 16, 2009

    Report

    Report Number
    MW5012768
    Event Type
    Injury
    Date Received
    September 16, 2009
    Date of Event
    August 7, 2009
    Report Date
    September 3, 2009
    Manufacturer
    SURGIMARK, INC
    Product Code
    GCY
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    KS, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    IN 2009, INSERTION OF JACKSON PRATT #10 DRAIN INSERTED. THE FOLLOWING MONTH, REMOVAL OF JACKSON PRATT DRAIN. THE SAME DAY, DEBRIDEMENT OF NEUROTIC WOUND. SHORT PIECE OF THE JACKSON PRATT DRAIN FOUND & REMOVED. WHEN REMOVED, PIECE OF DRAIN REMAINED IN THE WOUND. DIAGNOSIS: I&D OF POSTOPERATIVE ABDOMINAL WOUND HEMATOMA.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DRAIN TOW JP JACKSON PRATT DRAIN GCY SURGIMARK, INC 396128

    Patients

    Seq Age Sex Outcome Treatment
    1 40 YR Required Intervention