BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BECTON, DICKINSON & CO.

    MDR report key: 1345973 · Received March 16, 2009

    Report

    Report Number
    MW5010353
    Event Type
    Malfunction
    Date Received
    March 16, 2009
    Date of Event
    March 4, 2009
    Report Date
    March 16, 2009
    Manufacturer
    BECTON, DICKINSON & CO.
    Product Code
    JKA
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    TX, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PT HAD A TUNNELED RIGHT IJ CATHETER FOR HEMODIALYSIS, PLACED IN 2008. POST DIALYSIS LABS DRAWN FROM CATHETER USING LUER ADAPTER VACUTAINER. DURING REMOVAL LUER ADAPTER SNAPPED OFF INSIDE CATHETER PORT. SURGEON AND STAFF UNABLE TO REMOVE MANUALLY. PT TO OR FOR SURGICAL EXCHANGE OF CATHETER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BECTON, DICKINSON & CO. MULTISAMPLE VACUTAINER, LUER ADAPTER JKA BECTON, DICKINSON & CO. 8079938

    Patients

    Seq Age Sex Outcome Treatment
    1 67 YR Other