BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    10 FRENCH JACKSON-PRATT DRAIN

    MDR report key: 862877 · Received May 23, 2007

    Report

    Report Number
    862877
    Event Type
    Malfunction
    Date Received
    May 23, 2007
    Date of Event
    May 15, 2007
    Report Date
    May 22, 2007
    Manufacturer
    CARDINAL HEALTH MEDICAL PRODUCTS AND SERVICES
    Product Code
    GCY
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    SC, US

    Narratives

    Description of Event or Problem · 1

    THE PATIENT WAS UNDERGOING AN ABDOMINAL HYSTERECTOMY. WHEN THE PHYSICIAN WAS ATTEMPTING TO REMOVE THE JACKSON PRATT (JP) DRAIN, IT SNAPPED OFF IN THE PATIENT. THE PATIENT WAS RETURNED TO SURGERY THE FOLLOWING DAY FOR REMOVAL OF THE RETAINED PORTION OF THE JP DRAIN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 10 FRENCH JACKSON-PRATT DRAIN DRAIN, SURGICAL GCY CARDINAL HEALTH MEDICAL PRODUCTS AND SERVICES * 1060952

    Patients

    Seq Age Sex Outcome Treatment
    1 42 YR