BEUDAMED
    FDA Adverse Event Other Summary report: N

    BARD POLY-RADPICC 5FR

    MDR report key: 509119 · Received January 27, 2004

    Report

    Report Number
    509119
    Event Type
    Other
    Date Received
    January 27, 2004
    Date of Event
    January 20, 2004
    Report Date
    January 23, 2004
    Manufacturer
    BARD ACCESS SYSTEMS
    Product Code
    LJS
    Report Source
    User Facility report
    Reporter Location
    MO, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    DURING PICC LINE PLACEMENT BY RADIOLOGIST, THE TIP OF THE GUIDEWIRE WAS SHEARED OFF BY THE NEEDLE AND REMAINED IN THE SUBCUTANEOUS TISSUE. THE RADIOLOGIST WAS UNABLE TO RETRIEVE THE TIP OF THE WIRE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD POLY-RADPICC 5FR DUAL-LUMEN REVERSE TAPER POLYURETHANE CATHETER LJS BARD ACCESS SYSTEMS 110622KN83753S 22KN8375

    Patients

    Seq Age Sex Outcome Treatment
    1 93 YR Other