BEUDAMED
    FDA Adverse Event Injury Summary report: N

    VAXCEL PERIPHERALLY INSERTED CENTRAL CATHETER

    MDR report key: 1202353 · Received October 13, 2008

    Report

    Report Number
    MW5008659
    Event Type
    Injury
    Date Received
    October 13, 2008
    Date of Event
    September 22, 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

    A PICC LINE WAS INSERTED AND THE WHITE PORT VALVE BEGAN LEAKING. THE PICC LINE WAS REMOVED AND REPLACED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 VAXCEL PERIPHERALLY INSERTED CENTRAL CATHETER VAXCEL PICC LINE LJS BOSTON SCIENTIFIC PASV 5F 1276602

    Patients

    Seq Age Sex Outcome Treatment
    1 78 YR Disability