BEUDAMED
    FDA Adverse Event Other Summary report: N

    ANGEL WING 23 BCS W/LUER ADPTR

    MDR report key: 590002 · Received April 11, 2005

    Report

    Report Number
    1282497-2005-00003
    Event Type
    Other
    Date Received
    April 11, 2005
    Report Date
    March 1, 2005
    Manufacturer
    TYCO HEALTHCARE/KENDALL
    Product Code
    GJE
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    A CUSTOMER EXPERIENCED A PROBLEM WITH THE ANGEL WING BLOOD COLLECITON SYSTEM. THE CUSTOMER REPORTS THAT AFTER COMPLETING A VENI-PUNCTURE PROCEDURE THEY ATTEMPTED TO ACTIVATE THE SAFETY SHIELD AND IT WOULD NOT ACTIVATE, THUS INCURRING A CONTAMINATED NEEDLE STICK.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ANGEL WING 23 BCS W/LUER ADPTR * GJE TYCO HEALTHCARE/KENDALL * UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 * Death| O