BEUDAMED
    FDA Adverse Event Death Summary report: N

    BARD

    MDR report key: 242029 · Received September 28, 1999

    Report

    Report Number
    MW1017241
    Event Type
    Death
    Date Received
    September 28, 1999
    Date of Event
    July 9, 1999
    Report Date
    September 21, 1999
    Manufacturer
    C.R. BARD, INC. BARD ACCESS SYSTEMS
    Product Code
    DQO
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MN, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    DOUBLE LUMEN HICKMAN CATHETER BROKE AT BIFURCATION POINT CAUSING EXSANGUINATION. UNABLE TO CONFIRM IMPLANT DATE. THIS DEVICE WAS SENT TO THE MFR FOR NON-INVASIVE TESTING AND RETURNED TO RPTR'S OFFICE: APPARENT BLUNT TRAUMA.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD DOUBLE LUMEN HICKMAN CATHETER 13.5FR DQO C.R. BARD, INC. BARD ACCESS SYSTEMS UNK UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 75 YR Death