BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MEDLINE SILICONE DRAIN-HUBLESS

    MDR report key: 3052849 · Received April 5, 2013

    Report

    Report Number
    MW5029702
    Event Type
    Malfunction
    Date Received
    April 5, 2013
    Date of Event
    April 4, 2013
    Report Date
    April 4, 2013
    Manufacturer
    MEDLINE INDUSTRIES, INC.
    Product Code
    GCY
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PHYSICIAN WAS REMOVING THE TUBING FROM THE PT AND THE TIP FRACTURED, STAYING IN THE PT. REASON FOR USE: ABDOMINAL DRAIN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    139886 MEDLINE SILICONE DRAIN-HUBLESS SILICONE DRAIN-HUBLESS FLAT DRAIN, FULL PERFORATION GCY MEDLINE INDUSTRIES, INC. P1219461

    Patients

    Seq Age Sex Outcome Treatment
    1 27 YR