BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PICC LINE

    MDR report key: 1132863 · Received August 14, 2008

    Report

    Report Number
    MW5008064
    Event Type
    Malfunction
    Date Received
    August 14, 2008
    Date of Event
    July 16, 2008
    Report Date
    July 16, 2008
    Manufacturer
    BOSTON SCIENTIFIC CORP.
    Product Code
    LJS
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    OH, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PREPARING PICC LINE FOR INSERTION. UNABLE TO FLUSH RED PORT. DEVICE NOT USED ON A PATIENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PICC LINE LJS BOSTON SCIENTIFIC CORP. 1271232

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Other