BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BLAKE

    MDR report key: 2850079 · Received August 29, 2012

    Report

    Report Number
    2850079
    Event Type
    Malfunction
    Date Received
    August 29, 2012
    Date of Event
    August 27, 2012
    Manufacturer
    JOHNSON & JOHNSON MEDICAL, INC.
    Product Code
    KOG
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CA, US
    Reporter Occupation
    INVALID DATA

    Narratives

    Description of Event or Problem · 1

    WHILE ATTEMPTING TO REMOVE THE DRAIN LINE FROM THE PATIENT'S BACK, THE CATHETER BROKE LEAVING ABOUT 6 INCHES REMAINING IN THE PATIENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BLAKE APPARATUS, SUCTION, SINGLE PATIENT USE, PORTABLE, NONPOWERED KOG JOHNSON & JOHNSON MEDICAL, INC. * *

    Patients

    Seq Age Sex Outcome Treatment
    1 58 YR