BEUDAMED
    FDA Adverse Event Summary report: N

    HICKMAN, TRIFUSION

    MDR report key: 3202298 · Received June 26, 2013

    Report

    Report Number
    MW5030714
    Date Received
    June 26, 2013
    Date of Event
    June 14, 2013
    Report Date
    June 19, 2013
    Manufacturer
    BARD ACCESS SYSTEMS, INC.
    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 (B)(6) 2011. NEEDED TO HAVE CATHETER REPLACED. REPLACEMENT WITHOUT INCIDENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    289459 HICKMAN, TRIFUSION LJS BARD ACCESS SYSTEMS, INC. REVE1097

    Patients

    Seq Age Sex Outcome Treatment
    1 50 YR Required Intervention