BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SYRINGE - 5CC LUER LOCK

    MDR report key: 5986601 · Received September 27, 2016

    Report

    Report Number
    MW5065083
    Event Type
    Malfunction
    Date Received
    September 27, 2016
    Date of Event
    June 23, 2016
    Report Date
    September 27, 2016
    Manufacturer
    INTERNATIONAL MEDISURG CONNECTION INC.
    Product Code
    FMF
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    THE SYRINGE HAD A CRACK RESULTING IN THE PHYSICIAN GETTING SPRAYED IN THE EYE WITH A SALINE SOLUTION (WENT UNDER THE GOGGLES).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    633263 SYRINGE - 5CC LUER LOCK SYRINGE - 5CC LUER LOCK FMF INTERNATIONAL MEDISURG CONNECTION INC. 13-7814-1

    Patients

    Seq Age Sex Outcome Treatment
    1