BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    4 FR PICC BASIC TRAY W/M

    MDR report key: 390059 · Received April 19, 2002

    Report

    Report Number
    1720496-2002-00074
    Event Type
    Malfunction
    Date Received
    April 19, 2002
    Report Date
    March 18, 2002
    Manufacturer
    BARD REYNOSA S.A. DE C.V.
    Product Code
    DQO
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE DR PLACED ONE PICC NOTICED A LEAK IN THE PICC, NOTICED LEAK THAT WOULD HAVE BEEN SUB-Q IN THE PT HAD IT BEEN PLACED. NO OTHER INFO PROVIDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 4 FR PICC BASIC TRAY W/M LONG TERM INTRAVASCULAR CATHETER DQO BARD REYNOSA S.A. DE C.V. 7755405 22DL5847

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other