BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MORPHEOUS CT PICC

    MDR report key: 1032989 · Received April 21, 2008

    Report

    Report Number
    MW5006352
    Event Type
    Injury
    Date Received
    April 21, 2008
    Date of Event
    April 20, 2008
    Report Date
    April 21, 2008
    Manufacturer
    ANGIO-DYNAMICS
    Product Code
    LJS
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    UNSURE EXACTLY HOW IT HAPPENED, BUT THE HUB OF ONE PORT ON A 2L PERIPHERALLY INSERTED CENTRAL CATHETER, PICC CAME OFF. IF IT GOT CAUGHT IN THE SIDE RAIL THE WHOLE LINE SHOULD HAVE PULLED OUT. THE HUB SHOULD NOT HAVE COME APART. DATES OF USE: THREE DAYS, 2008. DIAGNOSIS OR REASON FOR USE: CENTRAL ACCESS FOR CVP MONITORING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MORPHEOUS CT PICC PICC LJS ANGIO-DYNAMICS 5FR 2L PICC 951642

    Patients

    Seq Age Sex Outcome Treatment
    1 Disability