BEUDAMED
    FDA Adverse Event Injury Summary report: N

    1CC INSULIN VANISHPOINT SYRINGE

    MDR report key: 449426 · Received March 18, 2003

    Report

    Report Number
    1647137-2003-00004
    Event Type
    Injury
    Date Received
    March 18, 2003
    Date of Event
    February 24, 2003
    Report Date
    March 18, 2003
    Manufacturer
    RETRACTABLE TECHNOLOGIES, INC.
    Product Code
    FMF
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PATIENT PERFORMING SELF INJECTION. PATIENT REACHED ACROSS CHEST WITH SYRINGE IN LEFT HAND AND INJECTED INSULIN INTO RIGHT SHOULDER WHEN THE NEEDLE BROKE OFF INTO SHOULDER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 1CC INSULIN VANISHPOINT SYRINGE SAFETY SYRINGE FMF RETRACTABLE TECHNOLOGIES, INC. 29 X 1/2 UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Hospitalization| R