BEUDAMED
    FDA Adverse Event Injury Summary report: N

    V-CATH PICC

    MDR report key: 394453 · Received March 29, 2002

    Report

    Report Number
    2925153-2002-00004
    Event Type
    Injury
    Date Received
    March 29, 2002
    Date of Event
    February 7, 2002
    Report Date
    March 7, 2002
    Manufacturer
    HDC CORPORATION
    Product Code
    DQO
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PICC INSERTED IN 2002. REMOVED THE FOLLOWING MONTH, AND FOUND BROKEN. RADIOLOGY SAYS IT MUST HAVE BROKEN BEFORE, PROBABLY DURING SOME FLUSHING EXERCISE. THE TIP IS LODGED IN THE SOFT TISSUE OF THE MEDIASTINUM, AND THE REST OUT OF THE VASCULAR SYSTEM. THE REMOVED PIECE OF CATHETER HAS BEEN RETAINED BY RISK MANAGEMENT. PATIENT OK. NO ADDITIONAL ACTION BEING TAKEN.

    Devices

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

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Required Intervention