BEUDAMED
    FDA Adverse Event Injury Summary report: N

    POWERPICC

    MDR report key: 25229513 · Received May 20, 2026

    Report

    Report Number
    3006260740-2026-03500
    Event Type
    Injury
    Date Received
    May 20, 2026
    Date of Event
    March 11, 2026
    Report Date
    May 5, 2026
    Manufacturer
    C.R. BARD, INC. (BASD) -3006260740
    Product Code
    LJS
    UDI-DI
    00801741086915
    PMA / PMN Number
    K102159
    Adverse Event
    Yes
    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 BY CUSTOMER THAT PICC DOUBLE LUMEN BROKEN BELOW CLAMP AND ABOVE CAP. THIS PART IS NOT LOOPED OR UNDER A DRESSING. PATIENT WAS ON CHEMO # 2/7, NEEDED TO RECEIVE MIDAZOLAM ORAL LIQUID VIA NG AT 0.5MG/KG X 1 PRIOR TO PICC PULL AND PIV WITH BLOODWORK. THERE WAS NO DELAY IN TREATMENT AS WE PROCEEDED WITH PIVS. ON (B)(6) - PROCEDURAL SEDATION / ANESTHETIC TO PULL THE BROKEN PICC.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    243569 POWERPICC PERIPHERALLY INSERTED CENTRAL CATHETER (PICC) LJS C.R. BARD, INC. (BASD) -3006260740 N/A REKN1506 00801741086915

    Patients

    Seq Age Sex Outcome Treatment
    1