BEUDAMED
    FDA Adverse Event Other Summary report: N

    DAVOL JP DRAIN

    MDR report key: 5741226 · Received June 17, 2016

    Report

    Report Number
    MW5062951
    Event Type
    Other
    Date Received
    June 17, 2016
    Date of Event
    June 7, 2016
    Report Date
    June 17, 2016
    Manufacturer
    CR BARD SURGICAL DIVISION
    Product Code
    GBX
    Report Source
    Voluntary report
    Reporter Location
    KS, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    WHILE THE PROVIDER WAS REMOVING THE BANDAGE OVER THE JP DRAIN, THE CLEAR PORTION OF THE DRAIN CAME APART FROM THE FLOAT, WHITE PORTION. LEAVING THE ACTUAL DRAIN PORTION INSIDE THE PATIENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    386344 DAVOL JP DRAIN DAVOL JP DRAIN GBX CR BARD SURGICAL DIVISION DAVOL FLAT SILICONE DRAIN 1/4"

    Patients

    Seq Age Sex Outcome Treatment
    1 67 YR Other