BEUDAMED
    FDA Adverse Event Injury Summary report: N

    HOSPIRA / ICU MEDICAL

    MDR report key: 2702059 · Received August 10, 2012

    Report

    Report Number
    MW5026506
    Event Type
    Injury
    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): ADMITTED WITH ABDOMINAL PAIN, WBCS WITHIN NORMAL LIMITS. READY FOR DISCHARGE (B)(6), TEMP 103.2, POSITIVE BLOOD CULTURES FOR (B)(6). ON (B)(6): RIGHT AC PERIPHERAL IV INSERTED. ON (B)(6): RIGHT AC TENDER, WARM, DISCONTINUED DUE TO LEAKING.

    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