BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BARD ACCESS SYSTEM

    MDR report key: 286845 · Received July 19, 2000

    Report

    Report Number
    MW1019345
    Event Type
    Injury
    Date Received
    July 19, 2000
    Date of Event
    July 19, 2000
    Report Date
    July 19, 2000
    Manufacturer
    C.R. BARD, INC.
    Product Code
    DQO
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    KY, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    REPAIRED GROSHONG PICC LINE WITH 4FR REPLACEMENT CONNECTOR. PICC LINE CAME OFF STYLET OF REPLACEMENT CONNECTOR. PICC WENT UP INTO ARM, SENT PT TO ER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD ACCESS SYSTEM REPLACEMENT CONNECTOR DQO C.R. BARD, INC. * *

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR Hospitalization| R