BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SUREFLO INJECTION PLUG

    MDR report key: 35760 · Received August 19, 1996

    Report

    Report Number
    MW1009763
    Event Type
    Injury
    Date Received
    August 19, 1996
    Date of Event
    July 11, 1996
    Report Date
    August 14, 1996
    Manufacturer
    TERUMO MEDICAL CORP.
    Product Code
    FOZ
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PT'S PICC CAP CRACKED ALLOWING FLUSH TO LEAK OUT OF PICC LINE, (AS WELL AS MEDICATION AND BLOOD).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 SUREFLO INJECTION PLUG HEPARIN LOCK FOZ TERUMO MEDICAL CORP. L868 TM1631

    Patients

    Seq Age Sex Outcome Treatment
    1 54 YR Other| R