BEUDAMED
    FDA Adverse Event Other Summary report: N

    ALLEGIANCE/CARDINAL HEALTH

    MDR report key: 557730 · Received December 6, 2004

    Report

    Report Number
    1043582-2004-00002
    Event Type
    Other
    Date Received
    December 6, 2004
    Date of Event
    October 31, 2004
    Report Date
    December 1, 2004
    Manufacturer
    MICROTEK MEDICAL, INC.
    Product Code
    GCY
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    TIPS OF DRAIN BROKE OFF IN PATIENT UPON REMOVAL. SURGERY RECEIVED TO REMOVE TIP.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ALLEGIANCE/CARDINAL HEALTH WOUND EVACUATION DEVICE GCY MICROTEK MEDICAL, INC. SU130-40ZD UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 * Required Intervention