BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BARD ACCESS SYSTEMS, INC.

    MDR report key: 3066330 · Received April 15, 2013

    Report

    Report Number
    MW5029809
    Event Type
    Injury
    Date Received
    April 15, 2013
    Date of Event
    December 14, 2011
    Report Date
    April 5, 2013
    Manufacturer
    BARD ACCESS SYSTEM, INC.
    Product Code
    DQO
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MO, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    TRIFUSION PLACEMENT (B)(6) 2011. RETURNED FOR BROKEN CLAMP (B)(6) 2011. REPLACED CATHETER. PATIENT PRESENTS TODAY FOR TRIFUSION CATHETER EXCHANGE SECONDARY TO BROKEN CLAMPS ON 2 OUT OF THE 3 HUBS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    161594 BARD ACCESS SYSTEMS, INC. HICKMAN, TRIFUSION DQO BARD ACCESS SYSTEM, INC. REVE1099

    Patients

    Seq Age Sex Outcome Treatment
    1 31 YR Required Intervention