BEUDAMED
    FDA Adverse Event Injury Summary report: N

    COOK INC

    MDR report key: 360659 · Received November 19, 2001

    Report

    Report Number
    360659
    Event Type
    Injury
    Date Received
    November 19, 2001
    Date of Event
    September 18, 2001
    Report Date
    October 12, 2001
    Manufacturer
    COOK, INC.
    Product Code
    DQO
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    OK, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    THE SMALL LUMEN END OF DEVICE (HUB TO CATHETER) CAME APART. THE CATHETER WAS REMOVED AND REPLACED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    52352 COOK INC CENTRAL VENOUS CATHETER (DOUBLE LUMEN) DQO COOK, INC. PICDS-601-MPIS 1079081

    Patients

    Seq Age Sex Outcome Treatment
    1 87 YR Required Intervention