BEUDAMED
    FDA Adverse Event Other Summary report: N

    TYCO/HEALTHCARE - KENDALL

    MDR report key: 558090 · Received August 27, 2004

    Report

    Report Number
    MW1033108
    Event Type
    Other
    Date Received
    August 27, 2004
    Date of Event
    August 20, 2004
    Report Date
    August 27, 2004
    Manufacturer
    TYCO/HEALTHCARE - KENDALL
    Product Code
    FMF
    Report Source
    Voluntary report
    Reporter Location
    NY, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    IV TEAM NURSE WAS DRAWING UP SOME STERILE SALINE IN SYRINGE IN PREPARATION FOR AN IV START. THE ENTIRE METAL NEEDLE BECAME DISLOGED STAYING IN THE RUBBER VIAL TOP OF THE SALINE. THE NEEDLE SEPARATED COMPLETELY FROM GRAY PLASTIC HUB THAT IS CONNECTED TO THE SAFETY CAP. THIS SITUATION OCCURRED ON TWO SEPARATE OCCASIONS WITH TWO DIFFERENT NURSES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TYCO/HEALTHCARE - KENDALL MONOJECT MAGELLAN 3CC SYRINGE WITH SAFETY NEEDLE FMF TYCO/HEALTHCARE - KENDALL 22G X 1 1/2" 411488

    Patients

    Seq Age Sex Outcome Treatment
    1 * Other