BEUDAMED
    FDA Adverse Event Injury Summary report: N

    V-CATH PICC

    MDR report key: 394445 · Received March 29, 2002

    Report

    Report Number
    2925153-2002-00006
    Event Type
    Injury
    Date Received
    March 29, 2002
    Date of Event
    February 21, 2002
    Report Date
    March 21, 2002
    Manufacturer
    HDC CORPORATION
    Product Code
    DQO
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NJ, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    CATHETER BROKE WHILE INSIDE THE PATIENT, AND MIGRATED INTO PULMONARY CIRCULATION. IT HAS BEEN RETRIEVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 V-CATH PICC 3 FR. CATHETER DQO HDC CORPORATION 306-166 1126

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Required Intervention