BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    HICKMAN

    MDR report key: 2151702 · Received June 27, 2011

    Report

    Report Number
    2151702
    Event Type
    Malfunction
    Date Received
    June 27, 2011
    Date of Event
    May 23, 2011
    Report Date
    June 27, 2011
    Manufacturer
    BARD ACCESS SYSTEMS
    Product Code
    LJS
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    MA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    DURING OUTPATIENT VISIT A PIN HOLE WAS FOUND IN A TRIPLE LUMEN 12 FRENCH HICKMAN LINE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HICKMAN CATHETER, PICC LJS BARD ACCESS SYSTEMS * HUUE1665

    Patients

    Seq Age Sex Outcome Treatment
    1 56 YR