BEUDAMED
    FDA Adverse Event Injury Summary report: N

    HICKMAN

    MDR report key: 21248 · Received March 14, 1994

    Report

    Report Number
    21248
    Event Type
    Injury
    Date Received
    March 14, 1994
    Date of Event
    December 27, 1993
    Report Date
    January 6, 1994
    Manufacturer
    BARD
    Product Code
    MDV
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    PA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    INFUSAPORT CATHETER FOUND TO BE BROKEN IN THE MID PORTION OF THE CATHETER WITH THE DISTAL END OF THE CATHETER FRAGMENT LYING IN THE RIGHT ATRIUM. IT WAS RETRIEVED VIA THE RIGHT FERMORAL VEIN SUCCESSFULY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HICKMAN Implant INFUSAPORT CATHETER MDV BARD 60227 3406491

    Patients

    Seq Age Sex Outcome Treatment
    1 26 YR Hospitalization| R RECEIVING TPN INFUSION BY PUMP AT HOME.