BEUDAMED
    FDA Adverse Event Other Summary report: N

    REDI-FOAM

    MDR report key: 71005 · Received February 18, 1997

    Report

    Report Number
    1932738-1997-90001
    Event Type
    Other
    Date Received
    February 18, 1997
    Date of Event
    February 14, 1997
    Report Date
    February 18, 1997
    Manufacturer
    MED-TEC INC.
    Product Code
    JAD
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THREE TECHNICIANS WERE SETTING UP A FOAM SIMULATION. ONE TECHNICIAN REPLACED THE CAP ON THE CHEMICAL AFTER MIXING. THE EXPANDING FOAM CAUSED THE BOTTLE TO RUPTURE AND FOAM CONTENTS WERE SPATTERED AROUND ROOM. THE FOAM CONTACTED ALL THREE TECHNICIANS WERE TAKEN TO THE ER TO REMOVE FOAM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 REDI-FOAM FOAMING AGENT JAD MED-TEC INC. MT-RA 25

    Patients

    Seq Age Sex Outcome Treatment
    1 * Other