BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DRAIN ROUND TROCAR PERFORATED 1/8X49 INC

    MDR report key: 5821700 · Received July 21, 2016

    Report

    Report Number
    MW5063623
    Event Type
    Injury
    Date Received
    July 21, 2016
    Date of Event
    July 14, 2016
    Report Date
    July 21, 2016
    Manufacturer
    BARD - DAVOD, OWENS AND MINOR DISTRIBUTION INC - BARD MEDICAL DIVISION
    Product Code
    GCY
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MI, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    PHYSICIAN ATTEMPTED TO REMOVE JACKSON PRATT POSTOP, INITIAL SURGERY DATE (B)(6) 2016. TUBING BROKE IN THE PATIENT LEAVING A PORTION IN THE PATIENT. PATIENT REQUIRED SURGERY ON (B)(6) 2016 TO REMOVE REMAINING PART OF JACKSON PRATT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    466402 DRAIN ROUND TROCAR PERFORATED 1/8X49 INC JACKSON PRATT DRAIN ROUND TROCAR GCY BARD - DAVOD, OWENS AND MINOR DISTRIBUTION INC - BARD MEDICAL DIVISION 0070710

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR Other| R