BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BARD ACCESS SYSTEMS, INC.

    MDR report key: 3174622 · Received June 14, 2013

    Report

    Report Number
    MW5030556
    Event Type
    Injury
    Date Received
    June 14, 2013
    Date of Event
    June 3, 2013
    Report Date
    June 3, 2013
    Product Code
    LJS
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MO, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    BROKEN CLAMP ON THE WHITE LUMEN OF THE PT'S TRIFUSION. TRIFUSION HAD BEEN IN PLACE SINCE LAST WINTER ((B)(6) 2012). NEEDED TO HAVE CATHETER REPLACED. REPLACEMENT WITHOUT INCIDENT. NO LONG TERM HARM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    271016 BARD ACCESS SYSTEMS, INC. HICKMAN, TRIFUSION LJS REWI0078

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR Required Intervention