BEUDAMED
    FDA Adverse Event Death Summary report: N

    NOT KNOWN AT THIS TIME

    MDR report key: 402247 · Received June 28, 2002

    Report

    Report Number
    402247
    Event Type
    Death
    Date Received
    June 28, 2002
    Date of Event
    June 15, 2002
    Report Date
    June 24, 2002
    Manufacturer
    NA
    Product Code
    DQO
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    TX, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    SUBCLAVIAN CENTRAL LINE DISCONNECTED WHEN PT STOOD UP, CAUSING AIR EMBOLUS RESULTING IN PT'S DEATH.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 NOT KNOWN AT THIS TIME SUBCLAVIAN CENTRAL LINE DQO NA NA NA

    Patients

    Seq Age Sex Outcome Treatment
    1 14 YR Death