BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    AUTO DROP

    MDR report key: 15361 · Received August 19, 1994

    Report

    Report Number
    MW1003119
    Event Type
    Malfunction
    Date Received
    August 19, 1994
    Report Date
    August 8, 1994
    Manufacturer
    SAGE PRODUCTS, INC.
    Product Code
    JKA
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    MEDICAL TECHNOLOGIST

    Narratives

    Description of Event or Problem · 1

    WHEN TUBE IS PUSHED INTO BLOOD NEEDLE HOLDER THE NEEDLE RELEASES FROM HOLDER AND IS PUSHED FURTHER INTO PT'S ARM AND LEFT DANGLING THERE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 AUTO DROP BLOOD NEEDLE HOLDER SYSTEM JKA SAGE PRODUCTS, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1 * Other