FDA Adverse Event Other Summary report: N

PREVENTION PLUS CHEMO ISOLATION GOWN

MDR report key: 2362240 · Received November 30, 2011

Report

Report Number
1417592-2011-00060
Event Type
Other
Date Received
November 30, 2011
Date of Event
October 27, 2011
Report Date
November 30, 2011
Manufacturer
MEDLINE INDUSTRIES, INC.
Product Code
FME
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Occupation
NURSE

Narratives

Additional Manufacturer Narrative · 1

WHEN THE CLINICIAN PUT ON THE GOWN, SHE IMMEDIATELY EXPERIENCED A RASH AROUND HER MOUTH AND ON HER FACE. SHE ALSO HAD DIFFICULTY BREATHING. SHE IS A KNOWN ASTHMATIC WITH MULTIPLE ALLERGIES. SHE USED HER INHALER, WAS SEEN BY THE OCCUPATIONAL HEALTH PRACTITIONER AND THEN GIVEN AN ANTIHISTAMINE WITH GOOD RESULTS. THE SAMPLE WAS NOT RETURNED FOR EVALUATION. WE HAVE NOT RECEIVED ANY OTHER SIMILAR COMPLAINTS FOR THIS PRODUCT. NO CORRECTIVE ACTION IS INDICATED AT THIS TIME.

Description of Event or Problem · 1

A CLINICIAN DEVELOPED A SEVERE ALLERGIC REACTION AFTER PUTTING ON THE GOWN.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 PREVENTION PLUS CHEMO ISOLATION GOWN ISOLATION GOWN FME MEDLINE INDUSTRIES, INC. NON27457M 1051824992

Patients

Seq Age Sex Outcome Treatment
1 UNK Required Intervention