FDA Adverse Event
Other
Summary report: N
PD L-CATH PERIPHERALLY INSERTED CENTRAL CATHETER
MDR report key: 1300903
·
Received January 23, 2009
Report
- Report Number
- 1710034-2009-00021
- Event Type
- Other
- Date Received
- January 23, 2009
- Date of Event
- November 7, 2008
- Report Date
- January 7, 2009
- Manufacturer
- BECTON DICKINSON INFUSION THERAPY SYSTEMS
- Product Code
- LJS
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- FL, US
- Reporter Occupation
- OTHER
Narratives
Additional Manufacturer Narrative · 1
CONCLUSIONS: A ROOT CAUSE COULD NOT BE DETERMINED AS THE SAMPLE WAS RETAINED AT THE HOSP AND NOT AVAILABLE FOR THE INVESTIGATION. THE DEVICE HISTORY COULD NOT BE REVIEWED AS THE LOT NUMBER IS UNK. DATE SUBMITTED: 1/22/09.
Description of Event or Problem · 1
WHILE CLEANING INJECTION CAP TO OBTAIN BLOOD CULTURE, THE PICC LINE BROKE. THE PICC LINE WAS IMMEDIATELY REMOVED WITHOUT FURTHER INCIDENT.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | PD L-CATH PERIPHERALLY INSERTED CENTRAL CATHETER | PERCUTANEOUS CATHETER | LJS | BECTON DICKINSON INFUSION THERAPY SYSTEMS | NA | UNK |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 24 YR | Other |