BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PICC LINE ADAPTER

    MDR report key: 6306724 · Received February 7, 2017

    Report

    Report Number
    6306724
    Event Type
    Malfunction
    Date Received
    February 7, 2017
    Date of Event
    March 24, 2016
    Report Date
    December 28, 2016
    Manufacturer
    RYMED TECHNOLOGIES, LLC
    Product Code
    FPA
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    OH, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE NURSE NOTICED THE PICC LINE ADAPTER WAS CRACKED AND THE PIECE BROKE OFF LEAVING THE CENTER CORE GREEN PIECE EXPOSED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    90748 PICC LINE ADAPTER ADAPTER FPA RYMED TECHNOLOGIES, LLC M00137

    Patients

    Seq Age Sex Outcome Treatment
    1 56 YR