BEUDAMED
    FDA Adverse Event Other Summary report: N

    BD INTEGRA SYRINGE

    MDR report key: 835112 · Received April 3, 2007

    Report

    Report Number
    MW1042494
    Event Type
    Other
    Date Received
    April 3, 2007
    Date of Event
    April 2, 2007
    Report Date
    April 2, 2007
    Manufacturer
    BECTON DICKINSON & COMPANY
    Product Code
    FMF
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    WHILE DRAWING UP AN INJECTION OF DEPO PROVERA, THE NEEDLE CAME COMPLETELY OFF THE SYRINGE AND STUCK IN THE "BLADDER" OF THE PRODUCT. POTENTIAL DANGER TO CLIENT IF NEEDLE CAME OFF WHILE IN HER HIP AT INJECTION OF MEDICATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BD INTEGRA SYRINGE RETRACTING NEEDLE 3ML 22G 1 1/2" SYRINGE FMF BECTON DICKINSON & COMPANY * 4124-351 CAV02

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Other