BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BD INSYTE AUTOGARD 22GA 1.00IN

    MDR report key: 6883270 · Received September 20, 2017

    Report

    Report Number
    MW5072257
    Event Type
    Injury
    Date Received
    September 20, 2017
    Date of Event
    September 11, 2017
    Report Date
    September 19, 2017
    Manufacturer
    BECTON, DICKINSON & COMPANY
    Product Code
    FOZ
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    A (B)(6) FEMALE ADMITTED TO THE EMERGENCY DEPARTMENT ON (B)(6) 2017 AT 13:34 AND ADMITTED TO THE INPATIENT SETTING ON (B)(6) 2017 AT 20:54. ON (B)(6) 2017 21:54, NURSE NOTIFIED PHYSICIAN THAT PATIENT REPORTED DISLODGED IV WHILE SHOWERING AND THAT THE CATHETER WAS NOT FOUND (PATIENT THOUGHT IT WAS RETAINED). SURGICAL RESIDENT DOCUMENTED IN ASSESSMENT THAT PATIENT STATED THAT WHEN NURSE FLUSHED IV SHE FELT A POP WITHIN THE VEIN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    658811 BD INSYTE AUTOGARD 22GA 1.00IN CATHETER, INTRAVASCULAR, THERAPEUTIC, SHORT-TERM FOZ BECTON, DICKINSON & COMPANY REF 381423 7089529

    Patients

    Seq Age Sex Outcome Treatment
    1 23 YR Required Intervention