FDA Adverse Event Malfunction Summary report: N

ANGIOMAT ILLUMENA

MDR report key: 680707 · Received February 3, 2006

Report

Report Number
680707
Event Type
Malfunction
Date Received
February 3, 2006
Date of Event
January 27, 2006
Report Date
February 3, 2006
Manufacturer
MALLINCKRODT INC DIV TYCO HEALTHCARE GROUP LP
Product Code
DXT
Product Problem
Yes
Report Source
User Facility report
Reporter Location
CA, US

Narratives

Description of Event or Problem · 1

A PATIENT IN THE CARDIAC CATHETERIZATION LAB WAS CONNECTED TO AN *INJECTOR WHEN THE SYRINGE DISINTEGRATED. THE INJECTOR HAD A PRE-FILLED SYRINGE (OPTIRAY ) ATTACHED, AND THE DEVICE OPERATOR HAD PRIMED IT. THE OPERATOR TAPPED IT TO GET RID OF THE BUBBLES IN THE SYRINGE. SYRINGE. WHEN THE OPERATOR INITIATED THE INJECTION OF THE SOLUTION, THE SYRINGE CAME APART. THE UNIT WAS REMOVED FROM THE DEPARTMENT AND SENT TO BIOMEDICAL ENGINEERING FOR FURTHER EXAMINATION. THE MANUFACTURER, MALLINCKRODT (LIEBEL-FLARSHEIM CO), WAS CONTACTED AND THEY SENT A TECHNICAL REPRESENTATIVE TO TEST THE UNIT. THEIR REPRESENTATIVE CONCLUDED THE UNIT WAS FUNCTIONING NORMALLY , SO THE ONLY SUSPECT COMPONENT REMAINING WAS THE SYRINGE. UNFORTUNATELY THE BROKEN SYRINGE WAS DISPOSED OF AT THE TIME OF THE INCIDENT. THE INJECTOR WAS RETURNED TO SERVICE. THE PATIENT WAS NOT HARMED BY THIS MALFUNCTION. THE VENDOR GENERATED A SERVICE REPORT AND SENT IT TO BIOMEDICAL ENGINEERING. THE REPORT INDICATED THE MACHINE WAS WITHOUT FAULT. THE ACTING SUPERVISOR WAS REMINDED THAT THE PERSONNEL IN THE DEPARTMENT NEED TO KEEP ALL COMPONENTS INVOLVED IN DEVICE INCIDENTS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 ANGIOMAT ILLUMENA INJECTOR DXT MALLINCKRODT INC DIV TYCO HEALTHCARE GROUP LP ANGIOMAT ILLUMINA *
2 OPTIRAY SYRINGE DXT MALLINCKRODT INC DIV TYCO HEALTHCARE GROUP LP OPTIRAY POSSIBLY HD48D, H281A OR J231A

Patients

Seq Age Sex Outcome Treatment
1 *