BEUDAMED
    FDA Adverse Event Injury Summary report: N

    VAXCEL PERIPHERALLY INSETED CENTRAL CATHETER

    MDR report key: 1202350 · Received October 13, 2008

    Report

    Report Number
    MW5008656
    Event Type
    Injury
    Date Received
    October 13, 2008
    Date of Event
    September 29, 2008
    Report Date
    October 13, 2008
    Manufacturer
    BOSTON SCIENTIFIC
    Product Code
    LJS
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PICC LINE INSERTED, BOTH LUMENS ASPIRATED AND FLUSHED. IMMEDIATE INCOMPETENCY OF THE WHITE LUMEN NOTED AS BLOOD WAS DRIPPING FROM IT. PICC LINE REMOVED AND REPLACED WITHOUT INCIDENCE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 VAXCEL PERIPHERALLY INSETED CENTRAL CATHETER VAXCEL PICC LINE LJS BOSTON SCIENTIFIC PASV 5F 1283022

    Patients

    Seq Age Sex Outcome Treatment
    1 Disability