BEUDAMED
    FDA Adverse Event Injury Summary report: N

    V-CATH

    MDR report key: 380242 · Received March 4, 2002

    Report

    Report Number
    MW1024241
    Event Type
    Injury
    Date Received
    March 4, 2002
    Date of Event
    March 1, 2002
    Report Date
    March 4, 2002
    Manufacturer
    HDC
    Product Code
    DQO
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    GA, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    PT DEVELOPED UPPER EXTREMITY SWELLING "NR" TO LINE; LINE DEVELOPED LEAK, VISIBLE HOLE/TEAR. WHEN NURSE ATTEMPTED TO DISCONTINUE LINE, LINE STRETCHED AND BROKE EXTERNALLY. PT SENT TO INTERVENTIONAL RADIOLOGY TO HAVE LINE REMOVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 V-CATH PICC, 5.0 FR. DUAL LUMEN DQO HDC * 1086

    Patients

    Seq Age Sex Outcome Treatment
    1 48 YR Required Intervention