BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ANGIODYNAMICS MORPHEUS SMART PICC CT

    MDR report key: 3040087 · Received April 2, 2013

    Report

    Report Number
    MW5029623
    Event Type
    Injury
    Date Received
    April 2, 2013
    Date of Event
    April 2, 2013
    Report Date
    April 2, 2013
    Manufacturer
    ANGIODYNAMICS, INC
    Product Code
    LJS
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    OK, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PT HAD ANGIODYNAMIC PICC LINE IN PLACE FOR 5 DAYS. BEDSIDE NURSE NOTIFIED PICC NURSE THAT THE PICC LINE HAD FRACTURED AT THE BASE OF THE RED HUB, AND WAS LEAKING FLUIDS AND BLOOD WAS LEAKING OUT. PICC LINE REMOVED AND NEW ONE PLACED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    134470 ANGIODYNAMICS MORPHEUS SMART PICC CT PICC LINE LJS ANGIODYNAMICS, INC 590554

    Patients

    Seq Age Sex Outcome Treatment
    1 30 YR Required Intervention