BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    JACKSON PRATT DRAIN

    MDR report key: 2091762 · Received May 4, 2011

    Report

    Report Number
    2091762
    Event Type
    Malfunction
    Date Received
    May 4, 2011
    Date of Event
    April 21, 2011
    Report Date
    May 4, 2011
    Manufacturer
    CARDINAL
    Product Code
    GCY
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    MT, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    NURSE ATTEMPTED TO REMOVE A SMALL JP DRAIN FROM THE NECK OF A YOUNG PT. SUTURE CLIPPED, DRAIN PULLED OUT 1 INCH, THEN A SNAP WAS FELT AND THE DRAIN CAME OUT WITH A JAGGED UNEVEN TIP. IT APPEARED NOT ALL THE DRAIN CAME OUT. THE PT WAS SUBSEQUENTLY SCANNED AND RETURNED TO THE OR THE NEXT DAY TO RETRIEVE THE REMAINING PORTION OF THE DRAIN. UNFORTUNATELY, THE END PIECE WAS NOT RETAINED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 JACKSON PRATT DRAIN JACKSON PRATT DRAIN GCY CARDINAL RD 7FR END PERF POSSIBLE 1090478 OR 1090950

    Patients

    Seq Age Sex Outcome Treatment
    1 9 YR