BEUDAMED
    FDA Adverse Event Other Summary report: N

    DRAIN JACKSONPRATT FL10MM3/4PF

    MDR report key: 553640 · Received November 5, 2004

    Report

    Report Number
    1423507-2004-00114
    Event Type
    Other
    Date Received
    November 5, 2004
    Date of Event
    September 8, 2004
    Report Date
    November 5, 2004
    Manufacturer
    CARDINAL HEALTH
    Product Code
    GCY
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    THE DOCTOR ATTEMPTED REMOVAL OF THE DRAIN IN HIS OFFICE. THE BULB CAME OUT WITH APPROX 3 INCHES OF TUBING. THE DRAIN WAS RETAINED IN THE PT AND HAD TO BE SURGICALLY REMOVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DRAIN JACKSONPRATT FL10MM3/4PF WOUND DRAIN GCY CARDINAL HEALTH SU130-1349 UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Required Intervention