BEUDAMED
    FDA Adverse Event Injury Summary report: N

    JACKSON PRATT CARDIOTORACIC DRAIN

    MDR report key: 5801815 · Received July 18, 2016

    Report

    Report Number
    5801815
    Event Type
    Injury
    Date Received
    July 18, 2016
    Date of Event
    June 17, 2016
    Report Date
    July 6, 2016
    Manufacturer
    EVCO PLASTICS, DIV. DON EVANS, INC
    Product Code
    GCD
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    CA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    NURSE PRACTITIONER REMOVED JP DRAIN FROM PATIENT. SHE THEN ADVISED PRIMARY RN THAT PATIENT WOULD NEED STAT CT HEAD TO EVALUATE FOR POSSIBLE RETAINED DRAIN FRAGMENT. PATIENT TAKEN TO SURGERY AND DRAIN FRAGMENT WAS REMOVED. PATIENT CONDITION REMAINED SAME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    455346 JACKSON PRATT CARDIOTORACIC DRAIN CONNECTOR, CATHETER GCD EVCO PLASTICS, DIV. DON EVANS, INC

    Patients

    Seq Age Sex Outcome Treatment
    1 71 YR Hospitalization| R