BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    V CATH PICC

    MDR report key: 67123 · Received February 6, 1997

    Report

    Report Number
    MW1010669
    Event Type
    Malfunction
    Date Received
    February 6, 1997
    Date of Event
    January 27, 1997
    Report Date
    January 28, 1997
    Manufacturer
    HDC
    Product Code
    DQO
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    WA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    INJECTION OF CT CONTRAST VIA PRESSURE INFUSER CAUSED RUPTURE OF DISTAL (BLUE) LUMEN AT CATHETER - WHITE HUB MOLDING JUNCTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 V CATH PICC PERIPHERALLY INSERTED CATHETER DQO HDC 395-50 1021

    Patients

    Seq Age Sex Outcome Treatment
    1 79 YR Other