BEUDAMED
    FDA Adverse Event Summary report: N

    HOSPIRA / ICU MEDICAL

    MDR report key: 2702046 · Received August 10, 2012

    Report

    Report Number
    MW5026505
    Date Received
    August 10, 2012
    Manufacturer
    SET SOURCE
    Product Code
    FPA
    Report Source
    Voluntary report
    Reporter Location
    MO, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    ON (B)(6), STARTED RIGHT FA PERIPHERAL IV AND REMOVED (B)(6), DUE TO INFILTRATION. ON (B)(6), I & D OF SITE (PURULENT DRAINAGE) CULTURE GREW (B)(6). ON (B)(6), PANCREATIC ABSCESS S/P DRAINAGE LIKELY SEEDED FROM BACTEREMIA.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HOSPIRA / ICU MEDICAL 7" PRESSURE INFUSION EXT SET FPA SET SOURCE NA 13-038-JW

    Patients

    Seq Age Sex Outcome Treatment
    1 Hospitalization MEDLINE IV START KIT