BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BARD

    MDR report key: 3170016 · Received June 10, 2013

    Report

    Report Number
    MW5030526
    Event Type
    Injury
    Date Received
    June 10, 2013
    Date of Event
    June 9, 2013
    Report Date
    June 10, 2013
    Manufacturer
    BARD ACCESS SYSTEMS
    Product Code
    LJS
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CO, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    (B)(6) FEMALE ADMITTED (B)(6) 2013 FOR SHORTNESS OF BREATH, COUGH AND FEVER. PICC LINE PLACED (B)(6) 2013 WITH BARD POWER PICC. CHEST RAY TO DOCUMENT PICC. CT SCAN (B)(6) 2013 DEMONSTRATED COILED HIGH DENSITY STRUCTURE IN MAIN PULMONARY ARTERY. WIRE REMOVED FROM MAIN PULMONARY ARTERY (B)(6) 2013, COATED WITH THROMBUS, PRESUMED TO BE BROKEN GUIDE WIRE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    261665 BARD POWER PICC LJS BARD ACCESS SYSTEMS POWER PICC REXB0651

    Patients

    Seq Age Sex Outcome Treatment
    1 73 YR Required Intervention