BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PICC-NATE 1.9 FR

    MDR report key: 1212028 · Received October 24, 2008

    Report

    Report Number
    MW5008768
    Event Type
    Injury
    Date Received
    October 24, 2008
    Date of Event
    October 6, 2008
    Report Date
    October 24, 2008
    Manufacturer
    UTAH MEDICAL
    Product Code
    LJS
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    DISCONNECTION OF EXTENSION T-PIECE TUBING FROM THE HUB, RESULTED IN SMALL LOSS OF BLOOD AND INTERVENTION TO REPLACE DEFECTIVE EXTENSION CONNECTOR. DIAGNOSIS OR REASON FOR USE: PREMATURITY. EVENT ABATED AFTER USE STOPPED OR DOSE REDUCED: YES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PICC-NATE 1.9 FR PICC 1.9 FR PERIPHERALLY INSERTED CATHETER LJS UTAH MEDICAL 1080364

    Patients

    Seq Age Sex Outcome Treatment
    1 2 DA Disability