FDA Adverse Event Death Summary report: N

AQUA SEAL CHEST DRAINAGE UNIT

MDR report key: 172541 · Received June 17, 1998

Report

Report Number
9611018-1998-00008
Event Type
Death
Date Received
June 17, 1998
Date of Event
June 11, 1998
Report Date
June 12, 1998
Manufacturer
SHERWOOD MEDICAL INDUSTRIES
Product Code
KDQ
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
TX, US
Reporter Occupation
UNKNOWN

Narratives

Additional Manufacturer Narrative · 1

REFERENCE MFR. COMPLAINT #98061603TL. THE ACTUAL SAMPLE WAS RETURNED. IT WAS TOO CONTAMINATED FOR PHYSICAL TESTING. HOWEVER, VISUAL EXAMINATION FOUND NO DEFECTS. R&D CHECKED THE UNIT AND REPORTED IT HAD TO HAVE FUNCTIONED PROPERLY TO ENABLE THE STAFF TO TRANSFUSE THE PT. BLOOD BAG WAS COMPLETELY DRY, INDICATING THE STAFF DID NOT FOLLOW MFG INSTRUCTIONS. "BLOOD SHOULD NOT BE INFUSED BELOW 50CC TO PREVENT AIR EMBOLISM FROM OCCURRING." THIS APPEARS TO BE A CASE OF USER ERROR.

Description of Event or Problem · 1

FOLLOW UP WITH THE CUSTOMER FOUND THE UNIT SET UP WAS GOOD AND THE IV SET UP LOOKED GOOD. HOWEVER, THE BLOOD BAG, WHICH HAD A PRESSURE INFUSION CUFF ATTACHED, WAS COMPLETELY DRY. THE UNIT WAS PHOTOGRAPHED BY THE HOSP.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 AQUA SEAL CHEST DRAINAGE UNIT CHEST DRAINAGE SYSTEM KDQ SHERWOOD MEDICAL INDUSTRIES NA UNK

Patients

Seq Age Sex Outcome Treatment
1 72 YR Death