BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BARD ACCESS SYSTEMS

    MDR report key: 1649734 · Received March 29, 2010

    Report

    Report Number
    MW5015357
    Event Type
    Malfunction
    Date Received
    March 29, 2010
    Date of Event
    March 25, 2010
    Report Date
    March 25, 2010
    Manufacturer
    BARD ACCESS SYSTEM
    Product Code
    DQO
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    DR WAS REMOVING TUNNEL CATH FROM PT'S CHEST AND BROKE. REST OF CATH REMOVED FROM PT SAFELY. DIAGNOSIS OR REASON FOR USE: NON HODGKIN'S LYMPHOMA.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD ACCESS SYSTEMS HICKMAN TRIFUSION DQO BARD ACCESS SYSTEM RETH0910

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR