BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWER LOC

    MDR report key: 3843007 · Received May 27, 2014

    Report

    Report Number
    MW5036381
    Event Type
    Malfunction
    Date Received
    May 27, 2014
    Date of Event
    May 14, 2014
    Report Date
    May 23, 2014
    Manufacturer
    BARD
    Product Code
    FPA
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NM, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    POWER LOC USED TO ACCESS PORT-A-CATH, DREW BACK ON SYRINGE AND NOTED AIR IN LINE, RE-FLUSHED LINE AND BLOOD ON GAUZE, REMOVED AND USED ANOTHER POWER LOC.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    311808 POWER LOC HUBER NEEDLE FPA BARD UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 35 YR Other