BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BARD ACCESS SYSTEMS

    MDR report key: 745429 · Received May 27, 2005

    Report

    Report Number
    MW1035602
    Event Type
    Injury
    Date Received
    May 27, 2005
    Date of Event
    May 11, 2005
    Report Date
    May 27, 2005
    Manufacturer
    BARD ACCESS SYSTEMS
    Product Code
    LJS
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    PICC LINE SEVERED INSIDE PT REQUIRING INTERVENTION TO REMOVE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD ACCESS SYSTEMS GROSHONG 5 FR D/L PICC LJS BARD ACCESS SYSTEMS 7927507 *

    Patients

    Seq Age Sex Outcome Treatment
    1 * Hospitalization| R