BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BARD ACCESS SYSTEMS, INC

    MDR report key: 3523177 · Received December 12, 2013

    Report

    Report Number
    MW5033447
    Event Type
    Injury
    Date Received
    December 12, 2013
    Date of Event
    November 27, 2013
    Report Date
    December 2, 2013
    Product Code
    LJS
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MO, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    TRIFUSION CATHETER PLACED ON (B)(6) 2013. CATHETER FUNCTIONING NORMALLY, UNTIL (B)(6) 2013 WHEN THE ONE OF THE CLAMPS (THE RED ONE) BROKE. THE CATHETER WAS EXPECTED FOR A NEOSTAR ON (B)(6) 2013.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    649803 BARD ACCESS SYSTEMS, INC HICKMAN, TRIFUSION LJS REWJ0820

    Patients

    Seq Age Sex Outcome Treatment
    1 56 YR Required Intervention