BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UNKNOWN

    MDR report key: 1982795 · Received January 31, 2011

    Report

    Report Number
    1982795
    Event Type
    Injury
    Date Received
    January 31, 2011
    Date of Event
    January 18, 2011
    Report Date
    January 24, 2011
    Manufacturer
    UNKNOWN
    Product Code
    DQO
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    TX, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    RECEIVED PT FROM (B)(4) FOR FOREIGN BODY POSSIBLY IN THE HEART AND PNEUMONIA. WHEN RECEIVED TO COVENANT MEDICAL CENTER, APPROX 6" PIECE OF CENTRAL LINE TYPE CATHETER REMOVED WITHOUT COMPLICATIONS. SEE INCLUDED DOCUMENTATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 UNKNOWN CENTRAL LINE DQO UNKNOWN UNK UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 43 YR Hospitalization| L