BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LIFEVAC PICC LINE, 4 FR

    MDR report key: 13044 · Received January 27, 1994

    Report

    Report Number
    13044
    Event Type
    Injury
    Date Received
    January 27, 1994
    Date of Event
    December 9, 1993
    Report Date
    December 10, 1993
    Manufacturer
    VYGON CORP.
    Product Code
    DQO
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    AZ, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PICC LINE THAT HAD BEEN PLACED ON 12/2/93 WAS FOUND BROKEN. THE DRESSING ON THE PICC IN THE LEFT ANTECUBITAL AREA WAS INTACT. THE PART OF THE CATHETER BROKEN WAS AT THE BOTTOM EDGE OF THE "WINGS" OF THE CATHETER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LIFEVAC PICC LINE, 4 FR Implant PICC LINE DQO VYGON CORP. 5800

    Patients

    Seq Age Sex Outcome Treatment
    1 86 YR Required Intervention