BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TRIPLE LUMEN CATHETER

    MDR report key: 493478 · Received November 3, 2003

    Report

    Report Number
    2518902-2003-00131
    Event Type
    Injury
    Date Received
    November 3, 2003
    Date of Event
    October 3, 2003
    Report Date
    October 8, 2003
    Manufacturer
    MEDCOMP
    Product Code
    JCY
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    PHARMACIST

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE "GUIDEWIRE BROKE DURING WITHDRAWAL".

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TRIPLE LUMEN CATHETER INFUSION CATHETER JCY MEDCOMP NA M340020

    Patients

    Seq Age Sex Outcome Treatment
    1 70 YR Required Intervention