BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PROTECTIVE PLUS-W 24GX5/8"

    MDR report key: 1802893 · Received August 12, 2010

    Report

    Report Number
    MW5017079
    Event Type
    Injury
    Date Received
    August 12, 2010
    Date of Event
    August 12, 2010
    Report Date
    August 12, 2010
    Manufacturer
    SMITHS MEDICAL
    Product Code
    FOZ
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    FL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    OCCURRED AT 5:50 AM. ISSUE INVOLVED PLACEMENT OF 24 GAUGE ANGIOCATH-SMITHS MEDICAL, PART # 3083- IN INFANT'S RIGHT ARM - ANTECUBITAL AREA - NEEDLE WITH CATHETER INSERTED PER PROTOCOL. NEEDLE REMOVED AND IT WAS NOTED THE ENTIRE CATHETER WAS SEPARATED FROM THE HUB WHICH REMAINED IN THE PT'S ARM. DATE OF USE: (B)(6) 2010. DIAGNOSIS OR REASON FOR USE: IV ANTIBIOTICS. EVENT ABATED AFTER USE: NO.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PROTECTIVE PLUS-W 24GX5/8" ANGIOCATH FOZ SMITHS MEDICAL ST1785797

    Patients

    Seq Age Sex Outcome Treatment
    1 1 DA Disability