BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    NOT KNOWN

    MDR report key: 1203824 · Received September 25, 2008

    Report

    Report Number
    1203824
    Event Type
    Malfunction
    Date Received
    September 25, 2008
    Report Date
    September 25, 2008
    Manufacturer
    BD INFUSION THERAPY SYSTEMS INC.
    Product Code
    LJS
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    DC, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    DURING PICC LINE REMOVAL, THE PICC LINE BROKE OFF WITH THE LINE REMAINING IN THE PATIENT. LINE REMOVED BY PLASTIC SURGEON. NO HARM TO PATIENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 NOT KNOWN CATHETER, PICC LJS BD INFUSION THERAPY SYSTEMS INC. NOT KNOWN NOT KNOWM

    Patients

    Seq Age Sex Outcome Treatment
    1 1 MO