inforMED
MalfunctionPEZ

DEROYAL VENOUS PACK BOWL

Received Jan 9, 2017 · Event occurred Jan 6, 2017

Report MW5067146 · MDR key 6237685

Device

Generic name

Venous Pack Bowl 16 Oz

Manufacturer

Deroyal

Model number

89-8672.02

Lot number

43483479

Product problems

  • Device Contamination with Chemical or Other Material

Patient

66 YR

  • No Patient Involvement
  • No Patient Involvement

Narrative

Description of Event or Problem

OPENED STERILE VENOUS PACK LOT #43483479 TO PREP FOR PT PROCEDURE. NOTED A SMALL BACK SPECK IN STERILE BOWL. NO SALINE OR OTHER PRODUCTS WERE ADDED TO THE BOWL. BLACK SPECK IS LOOSE AND MOVES IN BOWL. THE ENTIRE DRAPE WAS FOLDED, AND CLOSED AND ENTIRE TRAY NOT USED. THIS WAS NOTED BEFORE ANY PROCEDURE AND NO PRODUCTS FROM THIS TRAY CAME IN CONTACT WITH THE PT.