FDA Adverse Event
Other
Summary report: N
FIRST PICC PERIPHERALLY INSERTED CENTRAL CATHETER
MDR report key: 1356419
·
Received April 2, 2009
Report
- Report Number
- 1710034-2009-00062
- Event Type
- Other
- Date Received
- April 2, 2009
- Date of Event
- February 2, 2009
- Report Date
- March 6, 2009
- Manufacturer
- BECTON DICKINSON INFUSION THERAPY SYSTEMS
- Product Code
- FOZ
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- BR
- Reporter Occupation
- UNKNOWN
Narratives
Additional Manufacturer Narrative · 1
ADDITIONAL INFORMATION HAS BEEN REQUESTED, HOWEVER, THE HOSPITAL DID NOT HAVE ANY OTHER INFORMATION REGARDING THIS INCIDENT. THE SAMPLE WAS RECEIVED ON 03/23/2009 AND IS CURRENTLY BEING DECONTAMINATED. UPON DECONTAMINATION AND COMPLETION OF THE INVESTIGATION, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. (B) (4).
Description of Event or Problem · 1
THE CATHETER WAS INSERTED ON (B) (6) 2009 WITHOUT DIFFICULTY. ON (B) (6) 2009, THE CATHETER WAS FOUND BROKEN.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | FIRST PICC PERIPHERALLY INSERTED CENTRAL CATHETER | PERCUTANEOUS CATHETER | FOZ | BECTON DICKINSON INFUSION THERAPY SYSTEMS | NA | 8032493 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 6 DA | Other |