BEUDAMED
    FDA Adverse Event Injury Summary report: N

    POWERGLIDE MIDLINE CATHETER 20G, 10CM

    MDR report key: 3896198 · Received June 20, 2014

    Report

    Report Number
    MW5036809
    Event Type
    Injury
    Date Received
    June 20, 2014
    Date of Event
    June 18, 2014
    Report Date
    June 19, 2014
    Manufacturer
    BARD
    Product Code
    FOZ
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    TX, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    IV VASCULAR NURSE PLACING A MID-LINE CATHETER IN PATIENT'S ARM WITH US ASSISTANCE. WIRE BECAME BENT AND UNABLE TO CONTINUE TO THREADING DEVICE. RN ATTEMPTED TO PULL OUT ENTIRE PRODUCT. WOULD NOT MOVE FORWARD OF BACK. FINALLY ABLE TO PULL OUT BUT 6 CM OF CATHETER SHEERED OFF AND REMAINED IN PATIENT'S ARM. DIAGNOSIS OR REASON FOR USE: LONG TERM MEDICATION ADMINISTRATION. SECOND CATHETER USED. UNKNOWN WHICH AFFECTED PATIENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    364058 POWERGLIDE MIDLINE CATHETER 20G, 10CM POWERGLIDE MIDLINE CATHETER 20G, 10CM FOZ BARD REYA1540
    364059 POWERGLIDE MIDLINE CATHETER 20G, 10CM POWERGLIDE MIDLINE CATHETER 20G, 10CM FOZ BARD 0735143 1310R REYC0468

    Patients

    Seq Age Sex Outcome Treatment
    1 34 YR Required Intervention