BEUDAMED
    FDA Adverse Event Death Summary report: N

    PER-Q-CATH PICC

    MDR report key: 378285 · Received February 22, 2002

    Report

    Report Number
    1720496-2002-00027
    Event Type
    Death
    Date Received
    February 22, 2002
    Date of Event
    December 29, 2001
    Report Date
    January 30, 2002
    Manufacturer
    BARD ACCESS SYSTEMS
    Product Code
    DQO
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CO, US
    Reporter Occupation
    INVALID DATA

    Narratives

    Description of Event or Problem · 1

    CARDIAC TAMPONADE, RESULTING IN DEATH. PICC LINE WAS INSERTED VIA RIGHT ANTECUBITAL FOSSA AND LOCATION WAS CONFIRMED BY X-RAY. APPROX. 3 HOURS LATER, WHEN 10 CC OF TPN HAD BEEN ADMINISTERED, THE PT ARRESTED AND COULD NOT BE RESUSCITATED. AUTOPSY SHOWED PERICARDIAL TAMPONADE WITH LIKELY PERFORATION SITE BY THE PICC INTO THE ANTERIOR RIGHT VENTRICLE. REPORTED BY MEDWATCH.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PER-Q-CATH PICC LONG TERM INTRAVENOUS ACCESS DEVICE DQO BARD ACCESS SYSTEMS UNK NI

    Patients

    Seq Age Sex Outcome Treatment
    1