BEUDAMED
    FDA Adverse Event Other Summary report: N

    ABBOTT

    MDR report key: 364341 · Received November 27, 2001

    Report

    Report Number
    MW1023528
    Event Type
    Other
    Date Received
    November 27, 2001
    Date of Event
    November 9, 2001
    Report Date
    November 14, 2001
    Manufacturer
    ABBOTT LABORATORIES
    Product Code
    DQO
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    AZ, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    TIP OF TRIPLE LUMEN SNAPPED OFF WHEN PT CRAWLED OUT OF BED. ONLY ONE LUMEN SNAPPED OFF. 2 OTHERS REMOVED INTACT. CENTRAL LINE NOT PULLED OUT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    53474 ABBOTT CENTRAL VENOUS CATHETER DQO ABBOTT LABORATORIES LIFE SHIELD HIGH FLOW *

    Patients

    Seq Age Sex Outcome Treatment
    1 50 YR Other