FDA Adverse Event Injury Summary report: N

THORACENTESIS TRAY

MDR report key: 33155 · Received April 23, 1996

Report

Report Number
33155
Event Type
Injury
Date Received
April 23, 1996
Date of Event
March 26, 1996
Report Date
March 29, 1996
Manufacturer
PHARMASEAL DIV. BAXTER HEALTHCARE CORP.
Product Code
KDQ
Adverse Event
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

THORACENTESIS WAS PERFORMED USING THE 22G 2" NEEDLE FROM THE THORACENTESIS TRAY. 250CC FLUID WAS OBTAINED, AFTER INSTILLING LOCAL ANESTHESIA. UPON REMOVING THE 50CC SYRINGE (TO WHICH THE 22G NEEDLE WAS ATTACHED), THE NEEDLE CAME OFF OF THE RUBBER HUB. THE HUB REMAINED ATTACHED TO THE SYRINGE, WITH NO REMNANT OF THE NEEDLE ATTACHED. AN ATTEMPT WAS MADE TO RETRIEVE THE NEEDLE THROUGH A SMALL SKIN INCISION, BUT WAS UNSUCCESSFUL. THE PT WILL PROBABLY REQUIRE SURGICAL RETRIEVAL. THE DISTRIBUTOR IS RECALLING THE ENTIRE LOT.DEVICE NOT LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: FAIR CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY.NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.INVALID DATA - REGARDING EVALUATION BY USER AFTER EVENT. METHOD OF EVALUATION: ACTUAL DEVICE INVOLVED IN INCIDENT WAS EVALUATED, VISUAL EXAMINATION. RESULTS OF EVALUATION: COMPONENT FAILURE. CONCLUSION: DEVICE DISCARDED - UNABLE TO FOLLOW-UP. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: YES. CORRECTIVE ACTIONS: DEVICE RECALLED BY MANUFACTURER/DISTRIBUTOR. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 THORACENTESIS TRAY THORACENTESIS TRAY KDQ PHARMASEAL DIV. BAXTER HEALTHCARE CORP. L55003

Patients

Seq Age Sex Outcome Treatment
1 52 YR Required Intervention