BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    24 GAUGE L CATH PEEL AWAY SYSTEM

    MDR report key: 1010497 · Received February 13, 2008

    Report

    Report Number
    1010497
    Event Type
    Malfunction
    Date Received
    February 13, 2008
    Date of Event
    January 22, 2008
    Report Date
    February 13, 2008
    Manufacturer
    BECTON DICKINSON INFUSION THERAPY SYSTEMS
    Product Code
    LJS
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    IA, US

    Narratives

    Description of Event or Problem · 1

    NEWLY INSERTED PICC LINE DISLODGED WHEN IT WAS BEING REPOSITIONED. SEVEN CM OF THE CATHETER REMAINED INSIDE THE PATIENT REQUIRING SURGICAL RETRIEVAL AND THE NEED FOR A CENTRAL LINE TO BE PLACED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 24 GAUGE L CATH PEEL AWAY SYSTEM CATHETER, PICC LJS BECTON DICKINSON INFUSION THERAPY SYSTEMS * 7039277

    Patients

    Seq Age Sex Outcome Treatment
    1 18 DA