BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BARD

    MDR report key: 2100900 · Received May 19, 2011

    Report

    Report Number
    MW5020652
    Event Type
    Injury
    Date Received
    May 19, 2011
    Date of Event
    May 3, 2011
    Report Date
    May 10, 2011
    Manufacturer
    BARD MEDICAL DIVISION
    Product Code
    DQX
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CO, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    ATTEMPT TO PLACE PICC ON LEFT ARM IN BASILIC VEIN. UNABLE TO THREAD GUIDE WIRE, RESISTANCE MET. NEEDLE WITH WIRE PULLED OUT OF ARM TOGETHER, NOTED THAT WIRE WAS FRAYED AND PIECE APPEARED TO HAVE BROKEN OFF. SURGICAL REMOVAL ON (B)(6) 2011 REQUIRED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD GUIDE WIRE DQX BARD MEDICAL DIVISION REVC118

    Patients

    Seq Age Sex Outcome Treatment
    1 53 YR Required Intervention