BEUDAMED
    FDA Adverse Event Other Summary report: N

    COOK CRITICAL CARE/DIV. COOK INC.

    MDR report key: 389241 · Received June 26, 2002

    Report

    Report Number
    389241
    Event Type
    Other
    Date Received
    June 26, 2002
    Date of Event
    February 28, 2002
    Report Date
    March 5, 2002
    Manufacturer
    COOK INC.
    Product Code
    DQO
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    KY, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    DURING ATTEMPT TO INSERT CENTRAL LINE, DIFFICULTY WAS ENCOUNTERED WHEN REMOVING THE GUIDE WIRE. UPON REMOVAL OF THE GUIDE WIRE IT SHREDDED APART. STAFF WERE UNABLE TO DETERMINE IF ALL PIECES WERE ATTACHED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 COOK CRITICAL CARE/DIV. COOK INC. CENTRAL VENOUS CATHETERS DQO COOK INC. REORDER# C-PMS-500 *

    Patients

    Seq Age Sex Outcome Treatment
    1 48 YR Other