BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    *

    MDR report key: 3811976 · Received April 29, 2014

    Report

    Report Number
    3811976
    Event Type
    Malfunction
    Date Received
    April 29, 2014
    Date of Event
    April 28, 2014
    Report Date
    April 29, 2014
    Manufacturer
    M-TECH MEDICAL, INC
    Product Code
    NNI
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CO, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PHLEBOTOMIST DREW AN INPATIENT WITH A SYRINGE AND USED A TRANSFER DEVICE TO PUT THE BLOOD INTO THE BLUR TOP TUBE. ONCE SHE REMOVED THE TUBE FROM THE TRANSFER DEVICE, THE NEEDLE ATTACHED TO THE TRANSFER DEVICE STAYED IN THE TOP OF THE TUBE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    256899 * CONTAINER, SPECIMEN NNI M-TECH MEDICAL, INC * 306140104A

    Patients

    Seq Age Sex Outcome Treatment
    1 *