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        1. MPHO taxonomy
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  • Notify Booklet
    • 1 INTRODUCTION
    • 2 THE V&S CHAIN FOR MPHOs
    • 3 VIGILANCE AND SURVEILLANCE: HISTORY AND BASIC ELEMENTS
    • 4 MEDICAL PRODUCTS OF HUMAN ORIGIN (MPHO) - DONATION AND ETHICS
    • ANNEX 1. Notify Library - MPHO type taxonomy
    • 5 TOWARDS A GLOBAL GOVERNANCE OF MPHO
    • 6 THE V&S SYSTEM IS PRIMARILY A RESPONSIBILITY FOR HEALTH AUTHORITIES
    • 7 ORGANIZATION FOR A COMPREHENSIVE - VIGILANCE & SURVEILLANCE SYSTEM
    • 8 VIGILANCE & SURVEILLANCE - RECOGNITION RELIES ON HEALTH CARE STAFF
    • 9 INVESTIGATING OCCURRENCES THAT COULD CAUSE HARM - LEARNING FROM ERRORS
    • 10 PROJECT NOTIFY
    • 11 THE NOTIFY DATABASE - LEARNING FROM VIGILANCE
    • 12 RISKS ASSOCIATED WITH LIVING DONATION
    • 13 HARM TO RECIPIENT - INFECTIONS
    • 14 HARM TO RECIPIENT - NON INFECTIOUS BLOOD TRANSFUSION REACTIONS
    • 15 HARM TO RECIPIENTS - MALIGNANCY
    • 16 HARM TO RECIPIENTS - GENETIC TRANSMISSIONS - HPC
    • 17 HARM TO RECIPIENTS - GENETIC TRANSMISSIONS - gamets and embryos
    • 18 CHARACTERISTICS, HANDLING AND CLINICAL ERRORS
    • 19 TRACEABILITY, AN ABSOLUTE PRE-REQUISITE FOR MPHO SAFETY
    • ANNEX 2. Notify Library - Adverse occurrence type taxonomy
    • REFERENCES
  • Background Documents
Home / Risk of harm / Unsuitable MPHO released for clinical use - no harm

Unsuitable MPHO released for clinical use - no harm

Code: 
1.4.3

Inner package label and outer package label not matched, graft discarded

156
  • Read more about Inner package label and outer package label not matched, graft discarded

Poor graft quality made surgery more difficult

155
  • Read more about Poor graft quality made surgery more difficult

Only half as many bone chips in package as labeled, requiring delay to retrieve a second deposit

153
  • Read more about Only half as many bone chips in package as labeled, requiring delay to retrieve a second deposit

Inability to identify recipient of tissue during recall

152
  • Read more about Inability to identify recipient of tissue during recall

Vacuum pack tested and loss of vacuum determined, graft discarded

150
  • Read more about Vacuum pack tested and loss of vacuum determined, graft discarded

Tissue determined to be of unacceptable quality by surgeon and discarded

149
  • Read more about Tissue determined to be of unacceptable quality by surgeon and discarded

Broken bottle of bone graft

147
  • Read more about Broken bottle of bone graft

Bone graft with rheumatoid arthritis

142
  • Read more about Bone graft with rheumatoid arthritis

Bone graft with paget's disease

141
  • Read more about Bone graft with paget's disease

Distribution of cryopreserved skin without review of bacterial test results.

128
  • Read more about Distribution of cryopreserved skin without review of bacterial test results.

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Disclaimer

The cases, bibliography and associated comments included in this website and database have been provided by experts worldwide and reviewed by voluntary editorial working groups. The data and information is not guaranteed to be complete or to be fully up to date at any particular moment and it reflects the knowledge and views of the experts participating, not those of the World Health Organisation or the Italian National Transplant Centre.