BEUDAMED
    FDA Adverse Event Other Summary report: N

    ALLEGIANCE HEALTHCARE CORP.

    MDR report key: 802182 · Received June 13, 2006

    Report

    Report Number
    MW1041527
    Event Type
    Other
    Date Received
    June 13, 2006
    Date of Event
    May 31, 2006
    Report Date
    May 31, 2006
    Manufacturer
    ALLEGIANCE HEALTHCARE CORPORATION
    Product Code
    GCY
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PT HAD SURGERY IN 2006 FOR LUMBAR DECOMPRESSION, HEMOVAC DRAIN PLACED IN WOUND AT TIME OF SURGERY. DRAIN REMOVED IN AM BY MD. HE NOTED A PIECE BROKE OFF. PT HAD TO RETURN TO SURGERY FOR WOUND EXPLORATION AND REMOVAL OF CATHETER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ALLEGIANCE HEALTHCARE CORP. JACKSON PRATT DRAIN 400 ML RESERVOIR GCY ALLEGIANCE HEALTHCARE CORPORATION 44-2462 *

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR Other