BEUDAMED
    FDA Adverse Event Injury Summary report: N

    JP DRAIN

    MDR report key: 1656763 · Received April 9, 2010

    Report

    Report Number
    1656763
    Event Type
    Injury
    Date Received
    April 9, 2010
    Date of Event
    December 11, 2009
    Report Date
    April 6, 2010
    Product Code
    GBY
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    FL, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    EVENT DISCOVERED DURING RETROSPECTIVE CORE MEASURE REVIEW: PHYSICIAN/PA PROGRESS NOTE OF (B)(6) 2009 INCLUDES "JP: 10CC - REMOVED - HAD TO REOPEN LE INC SITE TO REMOVE JP DRAIN THAT BROKE. REMAINING DRAIN PIECE REMOVED INTACT. SKIN CLOSED WITH STAPLES."

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 JP DRAIN GBY

    Patients

    Seq Age Sex Outcome Treatment
    1 65 YR Required Intervention