BEUDAMED
    FDA Adverse Event Death Summary report: N

    UNKNOWN PREFILL

    MDR report key: 1629842 · Received March 9, 2010

    Report

    Report Number
    3002859087-2010-00097
    Event Type
    Death
    Date Received
    March 9, 2010
    Report Date
    March 5, 2010
    Manufacturer
    COVIDIEN
    Product Code
    NZW
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    AN INVESTIGATION IS CURRENTLY UNDERWAY. UPON COMPLETION, THE RESULTS WILL BE FORWARDED.

    Description of Event or Problem · 1

    ON (B) (6) 2010 COVIDIEN WAS INFORMED OF A CUSTOMER WHO HAD AN ISSUE WITH A HEPARIN PREFILLED SYRINGE. THE ATTORNEY ALLEGES THAT THE PT WAS ADMITTED TO THE HOSPITAL ON (B) (6) 2007. WHILE HOSPITALIZED, THE PT WAS ADMINISTERED HEPARIN AND BEGAN TO HAVE SYMPTOMS CONSISTENT WITH THE HYPERSENSITIVITY-TYPE ADVERSE REACTIONS FROM CONTAMINATED HEPARIN. UPON INFO AND BELIEF, ON AT LEAST ONE OCCASION, THE HEPARIN ADMINISTERED WAS ALLEGED TO BE CONTAMINATED HEPARIN. THE PT PASSED ON (B) (6) 2008.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 UNKNOWN PREFILL HEPARIN PREFILL NZW COVIDIEN UNKNOWN PREFILL UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK Death