FDA Adverse Event Injury Summary report: N

PISTON PLASTIC SYRINGE LIDOCAINE HCL 2% (URO-JET) REGULATION NO. 880.5860

MDR report key: 18960435 · Received March 21, 2024

Report

Report Number
MW5153066
Event Type
Injury
Date Received
March 21, 2024
Date of Event
February 28, 2022
Report Date
March 19, 2024
Manufacturer
UNKNOWN
Product Code
FMF
Adverse Event
Yes
Product Problem
Yes
Report Source
Voluntary report
Reporter Location
MI, US
Reporter Occupation
PATIENT
Health Professional
*

Narratives

Description of Event or Problem · 0

THIS PT (PATIENT) HAD RECTAL SURGERY FULGURATION RESULTING IN COMPLICATIONS THAT LEAD TO AMBULANCE ER CARE. UNCONTROLLED BLEEDING AND PAIN. IN ER (EMERGENCY ROOM) EXAM DR. (B)(6) UNABLE TO COMPLETE DRE (DIGITAL RECTAL EXAM) SOUGHT OTHER METHOD RETURNING TO PT ROOM WITH INSTRUMENT LATER ID AS IMS PISTON SYRINGE LIDOCAINE HCL 2%. THE VA (VETERANS AFFAIR) (B)(6) DOCTOR THEN ATTEMPTED TO INTERNALLY INSERT AND INJECT THE REGULATED MEDICATION BY NON-PRESCRIBED METHOD OF MANUFACTURER (WHOM I LATER CALLED) THE PISTON DEVICE FELT SHARP AND RAGGED LIKE IT WAS CUTTING ME INSIDE THE RECTUM DURING THE INSERTION CAUSING SEVERE PAIN TO POINT STUDENT TRAINEE CAME AROUND BED ASKING ME TO SQUEEZE HER HAND. I ONLY WANTED THE DEVICE REMOVED AND PROCEDURE STOPPED. INSISTENT 3-4 TIMES TO STOP AND BEING TOLD JUST BARE IT. I AT DISCHARGE OBTAINED THE BEDSIDE DEVICE AND ONCE HOME, I RESEARCHED MANUFACTURER INSERT ON FDA WEBSITE THAT STATED INTENDED FOR EXTERNAL USE ONLY, IN URETHRA (MALE/ FEMALE) NOT INTENDED IN RECTAL/RECTUM EXAM. I THERE AFTER DEVELOPED HEART ISSUES AND PTSD (POST-TRAUMATIC STRESS DISORDER) NIGHTMARE FROM WHAT CLINICAL PSYCHIATRIST STATES IS SEXUAL TRAUMA PTSD. THE USE OF THE CLASS II DEVICE, AND AFTER EXAMINING THE PLASTIC URO-JET SYRINGE, IT WAS FOUND TO HAVE HAD RAISED PLASTIC EDGES FROM INJECTED MOLDED PROCESS THAT WERE NOT ADDRESSED IN QUALITY CONTROL AND ARE MORE THAN LIKELY WHY FELT LIKE CUTTING INSIDE OF MY RECTUM FROM JAGGED EDGES. THE DEVICES IS NOT THE REAL ISSUE BECAUSE IT WAS NEVER INTENDED TO BE FULL INSERTED INTERNALLY, ONLY THE TIP IS PRESCRIBED TO BE USED WHICH MEDICAL PRACTITIONER VIOLATED REGULATORY FDA PRESCRIBED USE. THE MANUFACTURER EMAILED ME ITS RECOMMENDED USE DOCUMENTS AFTER SPEAKING ON THE PHONE WITH (B)(4). AND (B)(4) @ 11:43 AM, ON THE PHONE INSISTING THIS WAS IMPROPER USE BY DOCTOR AND AGAINST THE INSERT MATERIAL AND RECOMMEND USE. THE ID ON THE LIDOCAINE REFLECTS (B)(4) LIDOCAINE HYDROCHLORIDE JELLY USP, 2% A STERILE, WATER-SOLUBLE, TOPICAL ANESTHETIC. AND BAR CODE (B)(4), (B)(4) (100 MG AND RX ONLY). VA INDICATES NO RX (PRESCRIPTION) WAS NEED AS THE MEDICATION IS READILY AVAILABLE IN ER STATION. REPORTED COMPLAINT TO PRIVACY MANGER, ER MANAGER AND THE VA CHIEF OF STAFF AS WELL AS (B)(6). THE VA INVESTIGATION INTO USE OF THE DEVICE CLAIMS THE DEVICE AND PLUNGER ARE NOT RX REGULATED FOR DISBURSEMENT IN ER SETTING AND WAS NEVER ORDERED FROM HOSPITAL PHARMACY BY THE DOCTOR PERFORMING ANAL EXAM ((B)(6) STATED). THIS TOO WOULD VIOLATE FDA POLICY AND PRINTED LABEL FOR RX USE OF A REGULATED CLASS II AGENT LIDOCAINE HCL 2%. TO BE DISPENSED ON A ORDER OF LICENSE PROFESSIONAL CFR 801.109 (B)(1) I ALSO HAVE THE COMMUNICATION FROM THE VA INVESTIGATOR WHOM I COMPLAINED TO ABOUT IMPROPER USE. IT SHOULD ALSO BE NOTED THE (B)(6) LICENSE BOARD HAS BEGUN PROCEEDINGS AGAINST THE DOCTOR FOR THE COMPLAINED OF USE AND REFUSAL TO ADHERE TO PATIENT RIGHTS TO NOT HAVE PROCEDURE BEGUN/CONTINUED AND U.S. PATIENT BILL OF RIGHTS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
427061 PISTON PLASTIC SYRINGE LIDOCAINE HCL 2% (URO-JET) REGULATION NO. 880.5860 SYRINGE, PISTON FMF UNKNOWN 76329-3011-5, 76329-3012-5,

Patients

Seq Age Sex Outcome Treatment
1 65 YR Male Required Intervention| S LIDOCAINE HCL 2%.