BEUDAMED
    FDA Adverse Event Other Summary report: N

    PER Q CATH 3FR

    MDR report key: 507957 · Received January 21, 2004

    Report

    Report Number
    507957
    Event Type
    Other
    Date Received
    January 21, 2004
    Date of Event
    October 18, 2003
    Report Date
    November 18, 2003
    Manufacturer
    BARD ACCESS SYSTEMS
    Product Code
    DQO
    Report Source
    User Facility report
    Reporter Location
    PA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    BLOCKED PICC LINE REMOVED PER PHYSICIAN ORDER. REMOVAL UNEVENTFUL. CATH REMOVED INTACT. ON FURTHER EXAM, A BEND WAS NOTED IN THE CATH. WHEN CATH WAS FLUSHED, SALINE LEAKED FROM AREA. AREA WAS APPROX 6 CM FROM UNCUT END.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PER Q CATH 3FR * DQO BARD ACCESS SYSTEMS * 22G5746

    Patients

    Seq Age Sex Outcome Treatment
    1 38 YR Other