BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PER-Q-CATH PLUS A SILICONE PERCUTANEOUS CVC

    MDR report key: 1070582 · Received July 1, 2008

    Report

    Report Number
    3006260740-2008-00025
    Event Type
    Malfunction
    Date Received
    July 1, 2008
    Date of Event
    June 3, 2008
    Report Date
    June 4, 2008
    Manufacturer
    C. R. BARD, INC. (BASD)
    Product Code
    LJS
    PMA / PMN Number
    K954104
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THE MANUFACTURER HAS RECEIVED THE SAMPLE AND WILL BE EVALUATED. RESULTS ARE EXPECTED SOON.

    Description of Event or Problem · 1

    LINE PLACED IN PT. CATHETER SEPARATED FROM THE HUB.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PER-Q-CATH PLUS A SILICONE PERCUTANEOUS CVC LJS C. R. BARD, INC. (BASD) RERJ0345

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention