BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CAVICIDE

    MDR report key: 2761339 · Received September 26, 2012

    Report

    Report Number
    1722021-2012-00030
    Event Type
    Injury
    Date Received
    September 26, 2012
    Report Date
    August 27, 2012
    Manufacturer
    METREX RESEARCH
    Product Code
    LRJ
    PMA / PMN Number
    K951123
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WI, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    THE EMPLOYEE REPORTED THAT HER SYMPTOMS WERE ALLEVIATED BY EITHER GETTING FRESH AIR OR USING A PREVIOUSLY PRESCRIBED ALBUTEROL INHALER. TO DATE, THE EMPLOYEE IS DOING FINE. THE PRODUCT INVOLVED IN THE ALLEGED INCIDENT WAS NOT RETURNED AND NO LOT NUMBER WAS PROVIDED; THEREFORE, NO INVESTIGATION CAN BE CONDUCTED.

    Description of Event or Problem · 1

    A COMPLAINANT ALLEGED THAT ONE (1) OF THEIR EMPLOYEES EXPERIENCED A REACTION TO CAVICIDE WITH SYMPTOMS OF COUGHING, SHORTNESS OF BREATH, AND ITCHY AND WATERY EYES, AFTER USING THE PRODUCT AT THEIR FACILITY APPROXIMATELY SIX (6) YEARS AGO.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CAVICIDE SURFACE DISINFECTANT LRJ METREX RESEARCH

    Patients

    Seq Age Sex Outcome Treatment
    1 48 YR Other| R