FDA Adverse Event
Other
Summary report: N
FIRST PICC
MDR report key: 550801
·
Received October 13, 2004
Report
- Report Number
- 1710034-2004-00079
- Event Type
- Other
- Date Received
- October 13, 2004
- Date of Event
- June 16, 2004
- Report Date
- September 14, 2004
- Manufacturer
- BECTON DICKINSON INFUSION THERAPY SYSTEMS
- Product Code
- DQO
- Adverse Event
- Yes
- Report Source
- Manufacturer report
Narratives
Description of Event or Problem · 1
THE PICC LINE WAS PLACED IN THE PT IN 6/2004. DURING REMOVAL FOUR DAYS LATER THE LINE BROKE AT THE 35 CM. MARK. AN X-RAY OF THE RIGHT ARM WAS PERFORMED AND SHOWED APPROX 3 CM OF THE CATHETER REMAINING IN THE PT. PT WAS ADMITTED FOR VASCULAR SURGERY AND CATHETER WAS SUCCESSFULLY REMOVED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | FIRST PICC | PERCUTANEOUS CATHETER | DQO | BECTON DICKINSON INFUSION THERAPY SYSTEMS | NA | 4043016 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 |