BEUDAMED
    FDA Adverse Event Summary report: N

    PICC NATE

    MDR report key: 2770916 · Received August 31, 2012

    Report

    Report Number
    2770916
    Date Received
    August 31, 2012
    Date of Event
    August 22, 2012
    Report Date
    August 31, 2012
    Manufacturer
    UTAH MEDICAL
    Product Code
    LJS
    Report Source
    User Facility report
    Reporter Location
    LA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PICC LINE CATHETER INCLUDED IN TRAY HAD A BURR ON THE END OF THE CATHETER. BURR WAS SEEN PRIOR TO INSERTION WHEN THE INSERTOR WAS INSPECTING THE LINE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PICC NATE CATHETER, INTRAVASCULAR, PICC LJS UTAH MEDICAL * 1120638

    Patients

    Seq Age Sex Outcome Treatment
    1 15 DA