inforMED
InjuryOII

PERCUST ARTHROGRAM TRAY

Received Mar 8, 2017 · Event occurred Feb 28, 2017

Report MW5068415 · MDR key 6399195

Device

Generic name

Arthrogram Tray

Manufacturer

Unk

Lot number

1630-17

Product problems

  • Adverse Event Without Identified Device or Use Problem

Patient

52 YR

  • Sepsis
  • Sepsis

Narrative

Description of Event or Problem

PT UNDERWENT MR ARTHROGRAM ON (B)(6) 2017 WITH RIGHT HIP INJECTED WITH OMNIPAQUE 300 ((B)(4)). GE HEALTHCARE (B)(4) PLUS NAROPIN 0.5% (B)(4) APP FRESENIUS (B)(4); PLUS, THIRD AGENT MAGNEVIST NDC (B)(4) BAYER LOT # 53540D AND UTILIZING THE PERCUST ARTHROGRAM TRAY (B)(4) EXP JUNE 2019 AND HAS BEEN ADMITTED TO (B)(4) MEDICAL CENTER WITH A SEPTIC HIP ON (B)(6) 2017. DOSE OR AMOUNT: 10 ML, FREQUENCY: ONCE, ROUTE: INTRA-ARTICULAR, 5 ML, ONCE, INTRA-ARTICULAR.