FDA Adverse Event Injury Summary report: N

MINI MAM

MDR report key: 4465 · Received February 3, 1993

Report

Report Number
4465
Event Type
Injury
Date Received
February 3, 1993
Date of Event
October 29, 1992
Report Date
January 29, 1993
Manufacturer
ROSS LABORATORIES
Product Code
FNN
Adverse Event
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

A NEWBORN WAS LYING IN CRIB ON ABDOMEN; HEAD TO SIDE WITH PACIFIER IN MOUTH. INFANT PUT LEFT RING FINGER THROUGH ONE OF THE HOLES IN THE WHITE PLASTIC SHEILD OF THE PACIFIER. WHEN DISCOVERED THE FINGER WAS SWOLLEN & NURSES HAD TO USE LOTION TO GET FINGER OUTDEVICE NOT LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: SATISFACTORY 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.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: VISUAL EXAMINATION. RESULTS OF EVALUATION: INVALID DATA. CONCLUSION: INVALID DATA. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: YES. CORRECTIVE ACTIONS: DEVICE PERMANENTLY REMOVED FROM SERVICE, USE OF ALL SIMILAR DEVICES STOPPED PERMANENTLY. THE DEVICE WAS NOT DESTROYED/DISPOSED OF.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 MINI MAM PACIFIER FNN ROSS LABORATORIES FAN 678 67041Q6

Patients

Seq Age Sex Outcome Treatment
1 0 MO Required Intervention