BEUDAMED
    FDA Adverse Event Other Summary report: N

    BARD 4 FR SINGLE LUMEN POWERPICC

    MDR report key: 3434285 · Received October 24, 2013

    Report

    Report Number
    MW5032401
    Event Type
    Other
    Date Received
    October 24, 2013
    Date of Event
    October 7, 2013
    Report Date
    October 11, 2013
    Manufacturer
    BARD ACCESS SYSTEMS, INC.
    Product Code
    LJS
    Report Source
    Voluntary report
    Reporter Location
    CO, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PATIENT HAD PICC INSERTED ON OR SHORTLY BEFORE (B)(6) 2013. PATIENT REFERRED TO RADIOLOGIST/CATH LAB FOR REMOVAL ON (B)(6) 2013, DUE TO KNOT IN PICC APPROX 2 CM FROM END. DOCTOR OFFICE UNABLE TO REMOVE IT. PICC REMOVED THROUGH IJ ACCESS USING SNARE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    546344 BARD 4 FR SINGLE LUMEN POWERPICC PICC LINE LJS BARD ACCESS SYSTEMS, INC. REXG0322

    Patients

    Seq Age Sex Outcome Treatment
    1 50 YR