BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    V CATH

    MDR report key: 401104 · Received June 19, 2002

    Report

    Report Number
    MW1025374
    Event Type
    Malfunction
    Date Received
    June 19, 2002
    Date of Event
    June 16, 2002
    Report Date
    June 18, 2002
    Manufacturer
    HDC CORP
    Product Code
    DQO
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    WA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PT IN RESTRAINTS (WRIST) HAD A SITTER IN ROOM WITH THEM. PT MANAGED TO PULL ON PICC AND SEVERED IT 1 CM FROM HUB OF WINGS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 V CATH PICC DUAL LUMEN DQO HDC CORP 395-60 1078

    Patients

    Seq Age Sex Outcome Treatment
    1 49 YR PICC EXCHANGE DONE.