FDA Adverse Event Other Summary report: N

PUNCTURE GUARD

MDR report key: 559904 · Received December 13, 2004

Report

Report Number
2025816-2004-00012
Event Type
Other
Date Received
December 13, 2004
Date of Event
September 16, 2003
Report Date
December 13, 2004
Manufacturer
ICU MEDICAL INC.
Product Code
FPA
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
CT, US
Reporter Occupation
ATTORNEY

Narratives

Description of Event or Problem · 1

IT WAS REPORTED VIA RECEIPT OF ATTORNEY CORRESPONDENCE THAT A CLINICIAN AT HOSPITAL, SUSTAINED "INJURIES... WHILE UTILIZING A NEEDLE MANUFACTURED BY ICU MEDICAL, INC., SPECIFICALLY A PUNCTURE GUARD WINGED SET." THE MANUFACTURER WAS NOTIFIED AS A RESULT OF AN INSURANCE/DISABILITY CLAIM REVIEW. LIMITED INFORMATION PROVIDED/AVAILABLE REGARDING THE INCIDENT, THE DEVICE AND THE NATURE OF THE INJURY. IT IS ALLEGED THAT "THE BLOOD VIAL BROKE AND SOMETHING MALFUNCTIONED ON THE NEEDLE". IT IS UNKNOWN WHAT TYPE OF PROCEDURE AND OR APPLICATION WAS BEING ATTEMPTED AND/OR IF THERE WERE ANY CONTRIBUTING CIRCUMSTANCES, I.E. WHETHER THE PT WAS COMBATIVE, UNCOOPERATIVE. IT IS ALSO UNKNOWN WHAT TYPE OF INJURY WAS SUSTAINED AT THE TIME OF THE INCIDENT, AND OR WHAT MEDICAL INTERVENTION, TREATMENT (S) MAY HAVE OCCURRED ETC. THIS REPORT IS BEING SUBMITTED AS A CAUTIONARY MEASURE AND DOES NOT CONSTITUTE AN ADMISSION THAT THE PUNCTURE GUARD WINGED SET CAUSED OR CONTRIBUTED TO THE REPORTED INCIDENT. LIMITED INFORMATION HAS BEEN PROVIDED REGARDING THE ALLEGED PRODUCT PROBLEM AND OR WHETHER THE ALLEGED PRODUCT PROBLEM OCCURRED AS A RESULT OF USER ERROR AND/OR TECHNIQUE. IT IS ALSO NOTED THAT THE FACILITY, HAS NOT REPORTED AND/OR CONTACTED THE DEVICE MANUFACTURER REGARDING ANY TYPE OF PRODUCT PROBLEM OR MALFUNCTION INVOLVING AN ICU MEDICAL INC. DEVICE. THE EXACT CAUSE OF THE REPORTED INCIDENT CANNOT BE DETERMINED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 PUNCTURE GUARD PUNCTURE GUARD WINGED SET FPA ICU MEDICAL INC. UNK UNK

Patients

Seq Age Sex Outcome Treatment
1 UNKNOWN Other