BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERPICC

    MDR report key: 25019796 · Received April 28, 2026

    Report

    Report Number
    3006260740-2026-02960
    Event Type
    Malfunction
    Date Received
    April 28, 2026
    Date of Event
    April 8, 2026
    Report Date
    April 15, 2026
    Manufacturer
    C.R. BARD, INC. (BASD) -3006260740
    Product Code
    LJS
    UDI-DI
    00801741034466
    PMA / PMN Number
    K091324
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    H11: SECTION A THROUGH F - THE INFORMATION PROVIDED BY BD REPRESENTS ALL OF THE KNOWN INFORMATION AT THIS TIME. DESPITE GOOD FAITH EFFORTS TO OBTAIN ADDITIONAL INFORMATION, THE COMPLAINANT / REPORTER WAS UNABLE OR UNWILLING TO PROVIDE ANY FURTHER PATIENT, PRODUCT, OR PROCEDURAL DETAILS TO BD. THE MANUFACTURER HAS RECEIVED THE SAMPLE AND WILL BE EVALUATED. A SUPPLEMENTAL WILL BE SUBMITTED WITH EVALUATION RESULTS.

    Description of Event or Problem · 0

    IT WAS REPORTED THAT PATIENT HAD THE PICC SINCE (B)(6) 2025 AND GETTING MEDICATION AT HOME AND NOTICED THE PICC WAS LEAKING WHEN FLUSHING. PT WENT TO THE ER REMOVED THE PICC AND REPLACED WITH ANOTHER PICC. IT WAS BROKEN AT THE 9CM MARK WHEN REMOVED. NO SECUREMENT DEVICE, ONLY TEGADERM IV ADVANCE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    192512 POWERPICC PERIPHERALLY INSERTED CENTRAL CATHETER (PICC) LJS C.R. BARD, INC. (BASD) -3006260740 N/A REKQ3093 00801741034466

    Patients

    Seq Age Sex Outcome Treatment
    1