BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ARGON MEDICAL DEVICES

    MDR report key: 3242797 · Received July 17, 2013

    Report

    Report Number
    MW5030976
    Event Type
    Malfunction
    Date Received
    July 17, 2013
    Date of Event
    July 17, 2013
    Report Date
    July 17, 2013
    Manufacturer
    ARGON MEDICAL DEVICES
    Product Code
    LJS
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    OK, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    THE PICC LINE CLOTTED PREMATURELY AND HAD TO BE REMOVED AND ANOTHER ONE PLACED. MEDICATION INFUSING AT TIME. NO HARM TO PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    332687 ARGON MEDICAL DEVICES PICC LINE LJS ARGON MEDICAL DEVICES 11042390

    Patients

    Seq Age Sex Outcome Treatment
    1 2 MO