BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    JACKSON PRATT DRAIN

    MDR report key: 412159 · Received August 19, 2002

    Report

    Report Number
    1423507-2002-00108
    Event Type
    Malfunction
    Date Received
    August 19, 2002
    Date of Event
    July 1, 2000
    Report Date
    August 18, 2002
    Manufacturer
    ALLEGIANCE HEALTHCARE CORP.
    Product Code
    GCY
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    RETRACTION OF A PORTION OF JACKSON PRATT TUBE INTO ABDOMINAL CAVITY OF PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 JACKSON PRATT DRAIN WOUND DRAIN GCY ALLEGIANCE HEALTHCARE CORP. UNKJP UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Required Intervention