BEUDAMED
    FDA Adverse Event Other Summary report: N

    JP GOLD 7FR, SILICONE DRAIN W/O

    MDR report key: 567120 · Received January 25, 2005

    Report

    Report Number
    1423507-2005-00009
    Event Type
    Other
    Date Received
    January 25, 2005
    Date of Event
    December 11, 2004
    Report Date
    January 25, 2005
    Manufacturer
    CARDINAL HEALTH
    Product Code
    GBX
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    FOLLOWING DENTAL SURGERY, THE DRAIN TUBE WAS TORN DURING REMOVAL FROM PT'S BODY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 JP GOLD 7FR, SILICONE DRAIN W/O WOUND DRAIN GBX CARDINAL HEALTH SU130-1330 1040210

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Required Intervention