BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BARD ACCESS SYSTEM

    MDR report key: 3080364 · Received April 22, 2013

    Report

    Report Number
    MW5029922
    Event Type
    Malfunction
    Date Received
    April 22, 2013
    Date of Event
    April 2, 2013
    Report Date
    April 22, 2013
    Manufacturer
    BARD ACCESS SYSTEMS
    Product Code
    LJS
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    PICC LINE FOUND TO BE LEAKING. WHEN EXAMINED FOUND SLIT IN PICC LINE CATHETER DISTAL TO INSERTION SITE. PICC WAS REMOVED AND REPLACED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    173256 BARD ACCESS SYSTEM PICC LJS BARD ACCESS SYSTEMS REXB0571

    Patients

    Seq Age Sex Outcome Treatment
    1 30 YR