BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ADAPTOR, HOLDER, SYRINGE

    MDR report key: 16894727 · Received May 9, 2023

    Report

    Report Number
    16894727
    Event Type
    Malfunction
    Date Received
    May 9, 2023
    Date of Event
    March 17, 2023
    Report Date
    April 28, 2023
    Manufacturer
    HOSPIRA, INC
    Product Code
    IQG
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    PA
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL
    Health Professional
    Yes

    Narratives

    Description of Event or Problem · 0

    WAS MIXING AN AZTREONAM DOSE THAT WAS NOT YET RECONSTITUTED AND WHEN I BROKE THE SEAL TO THE VIAL AND SQUEEZED THE MIXING SOLUTION IN WITH THE MED POWDER, THE BOTTOM OF THE VIAL SHATTERED, AND THE MEDICATION WAS LOST.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1901998 ADAPTOR, HOLDER, SYRINGE IQG HOSPIRA, INC GA5439AA

    Patients

    Seq Age Sex Outcome Treatment
    1 31025 DA Female