BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MEDLINE

    MDR report key: 2864850 · Received September 28, 2010

    Report

    Report Number
    2864850
    Event Type
    Injury
    Date Received
    September 28, 2010
    Date of Event
    September 17, 2010
    Report Date
    September 23, 2010
    Manufacturer
    MEDLINE INDUSTRIES, INC.
    Product Code
    EFQ
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    TX, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    COLONOSCOPY DONE ON (B)(6) 2010. CT EXAM DONE (B)(6) 2010 REVEALED POSSIBLE RETAINED SURGICAL SPONGE; SPONGE SURGICALLY REMOVED ON (B)(6) 2010.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MEDLINE LAP SPONGE EFQ MEDLINE INDUSTRIES, INC. MDS251518LF UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 89 YR Required Intervention