BEUDAMED
    FDA Adverse Event Death Summary report: N

    JEVITY

    MDR report key: 371976 · Received January 4, 2002

    Report

    Report Number
    371976
    Event Type
    Death
    Date Received
    January 4, 2002
    Date of Event
    December 27, 2001
    Report Date
    January 3, 2002
    Manufacturer
    ABBOTT-ROSS
    Product Code
    KPE
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    IV TUBING WAS INSERTED INTO A JEVITY CONTAINER. THE AUTOPSY DETERMINED THE CAUSE OF DEATH AS EMBOLI. THE JEVITY PRODUCT FLOWING THROUGH THE IV SITE WAS DETERMINED TO BE THE CAUSE OF THE EMBOLI.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 JEVITY PREMIXED FOOD SUPPLEMENT CONTAINER KPE ABBOTT-ROSS UNK UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 81 YR Death IV TUBING.