BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BD L CATH PICC LINE

    MDR report key: 2243999 · Received September 7, 2011

    Report

    Report Number
    MW5022168
    Event Type
    Malfunction
    Date Received
    September 7, 2011
    Date of Event
    August 24, 2011
    Report Date
    August 29, 2011
    Manufacturer
    BECTON DICKINSON
    Product Code
    LJS
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    LA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PICC LINE - 20 GAUGE 60 CM BROKE WHILE IN PATIENT ARM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BD L CATH PICC LINE PICC LINE LJS BECTON DICKINSON 9299979

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR