BEUDAMED
    FDA Adverse Event Other Summary report: N

    GROSHONG 4FR. SL

    MDR report key: 503091 · Received December 11, 2003

    Report

    Report Number
    MW1030530
    Event Type
    Other
    Date Received
    December 11, 2003
    Date of Event
    December 1, 2003
    Report Date
    December 1, 2003
    Manufacturer
    BARD ACCESS SYSTEM
    Product Code
    DQO
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PICC CATHETER BROKE AT THE JUNCTION OF THE HUB WHILE PERFORMING POWER FLUSH TO TROUBLE SHOOT PICC THAT MIGRATED TO RIJ. THE PICC LINE GROSHONG 4FR. 5L WAS INSERTED IN 2003.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 GROSHONG 4FR. SL PICC LINE DQO BARD ACCESS SYSTEM * 22FN4949

    Patients

    Seq Age Sex Outcome Treatment
    1 53 YR Other