BEUDAMED
    FDA Adverse Event Injury Summary report: N

    12 FR 3 LUMEN 16 CM CATHETER

    MDR report key: 22439 · Received May 5, 1995

    Report

    Report Number
    22439
    Event Type
    Injury
    Date Received
    May 5, 1995
    Date of Event
    April 27, 1995
    Report Date
    April 27, 1995
    Manufacturer
    ARROW
    Product Code
    LFK
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    OH, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    TRIPLE LUMEN CATHETER PLACED IN RIGHT FEMORAL VEIN FOR DIALYSIS. PT PULLED AT CATHETER AND THE PIGGY BACK PORT CAME OUT. PT BLED, CATHETER REMOVED. PT IS OK.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 12 FR 3 LUMEN 16 CM CATHETER Implant CATHETER LFK ARROW AK-1-044-5

    Patients

    Seq Age Sex Outcome Treatment
    1 64 YR Required Intervention