FDA Adverse Event Injury Summary report: N

COOK INCORPORATED

MDR report key: 4355 · Received September 11, 1992

Report

Report Number
4355
Event Type
Injury
Date Received
September 11, 1992
Date of Event
April 22, 1992
Report Date
May 4, 1992
Manufacturer
COOK CRITICAL CARE INC.
Product Code
GBP
Adverse Event
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

DOUBLE LUMEN CENTRAL LINE PLACED IN L SUBDIVISION CONTINUED TO LEAK PROFUSELY AT INSERTION SITE. ATTEMPT WAS MADE TO THREAD NEW CATHETER OVER A GUIDE WIRE @ ORIGINAL INSERTION. FOLLOWING SEVERAL ATTEMPTS, A PORTION OF WIRE WAS BROKEN OFF AND REMAINED LODGED IN VESSEL. PLACEMENT VERIFIED BY CXR; PT. RETURNED TO OR FOR SUCCESSFUL REMOVAL OF WIREDEVICE LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: CRITICAL CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY. NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: ACTUAL DEVICE INVOLVED IN INCIDENT WAS EVALUATED, VISUAL EXAMINATION. RESULTS OF EVALUATION: NONE OR UNKNOWN, NONE OR UNKNOWN, UNANTICIPATED, GUIDEWIRE. CONCLUSION: DEVICE FAILURE DIRECTLY CAUSED EVENT. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: INVALID DATA. CORRECTIVE ACTIONS: NONE OR UNKNOWN. THE DEVICE WAS NOT DESTROYED/DISPOSED OF.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 COOK INCORPORATED DOUBLE LUMEN CENTRAL VENOUS CATHETER TRAY GBP COOK CRITICAL CARE INC. 8 CM DL 5182 653790

Patients

Seq Age Sex Outcome Treatment
1 11 MO Required Intervention