BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BARD POWER PICC 3L CATHETER

    MDR report key: 6998874 · Received November 3, 2017

    Report

    Report Number
    MW5073120
    Event Type
    Injury
    Date Received
    November 3, 2017
    Date of Event
    November 1, 2017
    Report Date
    November 1, 2017
    Manufacturer
    BARD ACCESS SYSTEMS
    Product Code
    LJS
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    A 3L POWER INJECTABLE PICC WAS FOUND TO HAVE TIP MIGRATED TO LIJ. POWER PORT WAS FLUSHED IN AN ATTEMPT TO REPOSITION THE TIP USING POWER INJECTION SERIES. BUT IT WAS NOT SUCCESSFUL. CATHETER WAS REMOVED AND WAS FOUND TO HAVE A SIGNIFICANT HOLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    779795 BARD POWER PICC 3L CATHETER BARD POWER PICC 3L CATHETER LJS BARD ACCESS SYSTEMS UNK REAT1464

    Patients

    Seq Age Sex Outcome Treatment
    1 67 YR Required Intervention