BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PICC LINE

    MDR report key: 20999935 · Received December 20, 2024

    Report

    Report Number
    MW5163834
    Event Type
    Injury
    Date Received
    December 20, 2024
    Date of Event
    November 29, 2024
    Report Date
    December 18, 2024
    Manufacturer
    UNK
    Product Code
    LJS
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    PHARMACIST
    Health Professional
    Yes

    Narratives

    Description of Event or Problem · 0

    CAUSALITY: 39 YO FEMALE ADMITTED ON (B)(6) 2024 FOR SEPSIS 2/2 INFECTED PICC LINE AT THE LEFT UPPER EXTREMITY. PT WAS TREATED WITH ANTIBIOTICS AND DISCHARGED HOME IN STABLE CONDITION. PATIENT INITIALS: (B)(6). DATE OF AWARENESS: 12/18/2024. PT REMS ID: (B)(6). PROVIDER REMS ID: (B)(6). REPORTER: (B)(6).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    2623480 PICC LINE CATHETER, INTRAVASCULAR, THERAPEUTIC, LONG-TERM GREATER THAN 30 DAYS LJS UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 Female Hospitalization