BEUDAMED
    FDA Adverse Event Injury Summary report: N

    HDC CORPORATION

    MDR report key: 520129 · Received March 25, 2004

    Report

    Report Number
    MW1031678
    Event Type
    Injury
    Date Received
    March 25, 2004
    Date of Event
    March 24, 2004
    Report Date
    March 25, 2004
    Manufacturer
    HDC CORPORATION
    Product Code
    DQO
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    OH, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    AFTER FINISHING 15 DAY COURSE OF IV ANTIBIOTIC THERAPY, PT CAME IN TO HAVE PICC LINE REMOVED. CATHETER BROKE OFF INSIDE PT'S ARM AND HAD TO BE SURGICALLY REMOVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HDC CORPORATION SILICONE PICC LINE CATHETER DQO HDC CORPORATION * 1004

    Patients

    Seq Age Sex Outcome Treatment
    1 31 YR Required Intervention