BEUDAMED
    FDA Adverse Event Injury Summary report: N

    50-13172 SPECIAL PROCEDURE TRAY #6957

    MDR report key: 316107 · Received February 12, 2001

    Report

    Report Number
    316107
    Event Type
    Injury
    Date Received
    February 12, 2001
    Date of Event
    January 10, 2001
    Report Date
    February 9, 2001
    Manufacturer
    DEROYAL INC.
    Product Code
    LRO
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    TN, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE CUSTOMER CLAIMS THAT THE 10CC SYRINGE THAT IS CONTAINED INSIDE OF THIS TRAY LEAKED. ACCORDING TO REPORTER, WHEN THE RADIOLOGIST EXERTED PRESSURE ON THE FILLED SYRINGE, THE BLOOD AND CONTRAST FLUIDS SPRAYED ON TWO STAFF MEMBERS. THE SYRINGE WAS KEPT AND WILL BE RETURNED TO CO FOR TESTING. BLOOD FROM ALL OF THE STAFF MEMBERS AND THE PT WAS TESTED FOR DISEASE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    5240 50-13172 SPECIAL PROCEDURE TRAY #6957 CTG CUSTOM PROCEDURAL TRAY GENERAL LRO DEROYAL INC. 2 543415

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other| R