BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BD FIRST PICC 26 GA (1.9F) X 50 CM

    MDR report key: 2102238 · Received May 19, 2011

    Report

    Report Number
    2102238
    Event Type
    Malfunction
    Date Received
    May 19, 2011
    Date of Event
    May 4, 2011
    Report Date
    May 19, 2011
    Manufacturer
    BD
    Product Code
    FOZ
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    VA, US

    Narratives

    Description of Event or Problem · 1

    THE PICC LINE BROKE DURING PRIMING WITH A 10ML SYRINGE. A STICKER FROM THE PACKAGE WAS SAVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BD FIRST PICC 26 GA (1.9F) X 50 CM PICC LINE FOZ BD * 0300515

    Patients

    Seq Age Sex Outcome Treatment
    1 *