BEUDAMED
    FDA Adverse Event Other Summary report: N

    V-CATH

    MDR report key: 494028 · Received October 20, 2003

    Report

    Report Number
    2925153-2003-00008
    Event Type
    Other
    Date Received
    October 20, 2003
    Date of Event
    August 12, 2003
    Report Date
    September 1, 2003
    Manufacturer
    HDC CORP.
    Product Code
    DQY
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    ID, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    CATHETER PLACED IN 08/2003. REMOVED FOUR DAYS LATER. IT SNAPPED DURING REMOVAL. SURGICAL INTERVENTION NEEDED TO REMOVE IT. THE PT DISCHARGED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 V-CATH PICC CATHETER DQY HDC CORP. V-CATH 5 FR 1021

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Required Intervention