BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BD FIRST PICC

    MDR report key: 2243996 · Received September 7, 2011

    Report

    Report Number
    MW5022167
    Event Type
    Malfunction
    Date Received
    September 7, 2011
    Date of Event
    August 22, 2011
    Manufacturer
    BECTON DICKINSON
    Product Code
    FOZ
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    LA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PICC LINE BROKE WHILE A HOMEHEALTH NURSE WAS IN THE PROCESS OF A DRESSING CHANGE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BD FIRST PICC PICC LINE FOZ BECTON DICKINSON FIRST PICC 9334067

    Patients

    Seq Age Sex Outcome Treatment
    1 79 YR