BEUDAMED
    FDA Adverse Event Other Summary report: N

    ABBOTT

    MDR report key: 361339 · Received November 14, 2001

    Report

    Report Number
    MW1023427
    Event Type
    Other
    Date Received
    November 14, 2001
    Date of Event
    November 8, 2001
    Report Date
    November 8, 2001
    Manufacturer
    ABBOTT LABORATORIES
    Product Code
    DQO
    Report Source
    Voluntary report
    Reporter Location
    AZ, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    BLUE PORT OF TRIPLE LUMEN CATHETER BROKE AT PORT SITE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    51561 ABBOTT CENTRAL VENOUS CATHETER KIT DQO ABBOTT LABORATORIES 41414-04-23 73-160-SN

    Patients

    Seq Age Sex Outcome Treatment
    1 46 YR Other