BEUDAMED
    FDA Adverse Event Injury Summary report: N

    HDC CORPORATION

    MDR report key: 556344 · Received August 26, 2004

    Report

    Report Number
    MW1033104
    Event Type
    Injury
    Date Received
    August 26, 2004
    Date of Event
    August 7, 2004
    Report Date
    August 26, 2004
    Manufacturer
    HDC CORP.
    Product Code
    DQO
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    CATHETER CAME APART -RATHER THAN BREAK- AFTER BEING PLACED IN PT 3 DAYS EARLIER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HDC CORPORATION V-CATH PICC, 4 FR SINGLE LUMEN DQO HDC CORP. * 1060

    Patients

    Seq Age Sex Outcome Treatment
    1 4 YR Required Intervention