BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BARD ACCESS SYSTEMS

    MDR report key: 373876 · Received January 25, 2002

    Report

    Report Number
    373876
    Event Type
    Injury
    Date Received
    January 25, 2002
    Date of Event
    January 10, 2002
    Report Date
    January 22, 2002
    Manufacturer
    *
    Product Code
    DQO
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    4 FR GROSHONG PIC PLACED WITH TOURNIQUET OFF CONTINUED GETTING BACK. FLOW OF BLOOD FROM CATHETER, PLACED CONNECTOR AND EXTENSION TUBING, FLUSHED WITH NS USING A 10CC SYRINGE. FOUND A PIECE OF BLUE PLASTIC SITTING IN THE EXTENSION TUBING PICC DISCONNECTED. CATHETER TIP FOUND TO BE INTACT. PT APPEARS TO HAVE NO SIGNS OF SYMPTOMS OF RESPIRATORY DISTRESS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD ACCESS SYSTEMS GROSHONG 4FR SINGLE LUMEN PICC DQO * 7715400 *

    Patients

    Seq Age Sex Outcome Treatment
    1 49 YR Required Intervention