FDA Adverse Event Injury Summary report: N

33534-1992-00001

MDR report key: 1979 · Received November 23, 1992

Report

Report Number
33534-1992-00001
Event Type
Injury
Date Received
November 23, 1992
Date of Event
November 5, 1992
Report Date
November 16, 1992
Manufacturer
LAFAYETTE
Product Code
FGD
Adverse Event
Yes
Report Source
Distributor report
Reporter Location
UT, US
Reporter Occupation
UNKNOWN

Narratives

Description of Event or Problem · 1

PATIENT HAD ANAPHALACTIC REACTION TOWHAT WE SUSPECT WAS THE LATEX RETENSION CUFF ON A BARIUM ENEMA TIP. MEDICAL INTERVENTION WAS REQUIRED INCLUDING THE INJECTION OF EPINEPHRINE, SOLU-CORTEF, BENADRYL AND OXYGEN. AFTER TREATMENT PATIENT IMPROVED AND WAS HELD FOR OBSERVATION FOR ABOUT SIX HOURS BEFORE BEING DISCHARGED TOHOME. (E_Z_EM BAROSPERSE BARIUM & BAG WERE USED IN CONJUNCTION WITH ENEMA TIP. PRODUCT WAS NOT LABELED AS TO CONTENTS OR CONTRAINDICATIONSDEVICE NOT LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: SATISFACTORY CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY. IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE NOT USED AS LABELED/INDENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: VISUAL EXAMINATION. RESULTS OF EVALUATION: LABELING - INCOMPLETE, UNANTICIPATED ADVERSE REACTION - SHORT TERM. CONCLUSION: OTHER. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: UNKNOWN (CANNOT DETERMINE). CORRECTIVE ACTIONS: DEVICE PERMANENTLY REMOVED FROM SERVICE. THE DEVICE WAS DESTROYED/DISPOSED OF.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 FGD LAFAYETTE 4391

Patients

Seq Age Sex Outcome Treatment
1 47 YR Required Intervention