BEUDAMED
    FDA Adverse Event Other Summary report: N

    V-CATH

    MDR report key: 486085 · Received September 25, 2003

    Report

    Report Number
    2925153-2001-00024
    Event Type
    Other
    Date Received
    September 25, 2003
    Report Date
    September 25, 2003
    Manufacturer
    HDC CORP.
    Product Code
    DQO
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    BASED ON THE COMPLAINT, PATIENT CAME INTO ER WITH PICC LINE FRACTURED 1.5 INCH BELOW RUBBER ANCHOR. REMAINDER OF PICC LINE STILL IN PATIENT ARM. REMOVED WITHOUT SURGERY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 V-CATH 4 FR PICC SINGLE LUMEN DQO HDC CORP. 402-166 1025

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Required Intervention