BEUDAMED
    FDA Adverse Event Death Summary report: N

    QUICKCLOT

    MDR report key: 22921880 · Received August 29, 2025

    Report

    Report Number
    MW5175400
    Event Type
    Death
    Date Received
    August 29, 2025
    Date of Event
    December 21, 2021
    Report Date
    February 11, 2025
    Manufacturer
    Z-MEDICA, LLC
    Product Code
    QSY
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    US
    Reporter Occupation
    NURSE
    Health Professional
    Yes

    Narratives

    Description of Event or Problem · 0

    (B)(6) 2021 PATIENT WITH EPISTAXIS AND RIGHT NARE PACKED WITH QUICKCLOT X3 SPRAYED WITH AFRIN. (B)(6) RN NOTES INDICATE NASAL PACKING REMOVED. (B)(6) PATIENT DECOMPENSATES AND TRANSFERS TO ICU, UNDERGOES FLEXIBLE FIBEROPTIC BRONCHOSCOPY WITH FINDINGS OF GAUZE-LIKE MATERIAL EXTENDING FROM LEFT BRONCHUS ABOVE LEVEL OF CARINA TO THE DISTAL TRACHEA. CRITICAL CARE NOTES INDICATE MULTIFACTORIAL CIRCULATORY SHOCK WITH HYPERCAPNIA RELATED TO AIRWAY OBSTRUCTION AND SEPTIC PNA. REFERENCE REPORTS: MW5107443, MW5107443-1 AND MW5175399.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    2880234 QUICKCLOT HEMOSTATIC WOUND DRESSING WITHOUT THROMBIN OR OTHER BIOLOGICS QSY Z-MEDICA, LLC

    Patients

    Seq Age Sex Outcome Treatment
    1 73 YR Male Death AFRIN NASAL SPRAY.