BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PICC

    MDR report key: 3901844 · Received June 24, 2014

    Report

    Report Number
    MW5036878
    Event Type
    Injury
    Date Received
    June 24, 2014
    Date of Event
    June 12, 2014
    Report Date
    June 23, 2014
    Manufacturer
    ANGIODYNAMICS
    Product Code
    LJS
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    BOTH LUMENS OF DOUBLE LUMEN PICC CRACKED. PICC REMOVED AND NOT REPLACED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    368802 PICC PICC LJS ANGIODYNAMICS 4730256

    Patients

    Seq Age Sex Outcome Treatment
    1 62 YR Required Intervention