BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LUTHER L-CATH

    MDR report key: 370454 · Received January 4, 2002

    Report

    Report Number
    MW1023753
    Event Type
    Malfunction
    Date Received
    January 4, 2002
    Date of Event
    October 27, 2001
    Report Date
    December 27, 2001
    Manufacturer
    LUTHER MEDICAL PRODUCTS, INC.
    Product Code
    DQO
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NC, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    PICC LINE INSERTED. IT MIGRATED TO THE PA 3 DAYS LATER. AFTER BREAKAGE AND WAS RETRIEVED IN THE CATH LAB TWO DAYS LATER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LUTHER L-CATH PICC DQO LUTHER MEDICAL PRODUCTS, INC. * 1621

    Patients

    Seq Age Sex Outcome Treatment
    1 1 MO