BEUDAMED
    FDA Adverse Event Other Summary report: N

    POWER PICC

    MDR report key: 1205867 · Received October 20, 2008

    Report

    Report Number
    MW5008690
    Event Type
    Other
    Date Received
    October 20, 2008
    Date of Event
    October 4, 2008
    Report Date
    October 20, 2008
    Manufacturer
    BARD ACCESS SYSTEMS, INC.
    Product Code
    LJS
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    TX, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PICC LINE BEING PLACED IN RIGHT UPPER EXTREMITY USING ULTRASOUND AND MODIFIED SELDINGER TECHNIQUE. PORTION OF GUIDEWIRE BROKE OFF AND BECAME LODGED IN THE PATIENT'S ARM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 POWER PICC NONE LJS BARD ACCESS SYSTEMS, INC. RESH0238

    Patients

    Seq Age Sex Outcome Treatment
    1 54 YR Other