BEUDAMED
    FDA Adverse Event Other Summary report: N

    COOK

    MDR report key: 752940 · Received June 17, 2005

    Report

    Report Number
    MW1035800
    Event Type
    Other
    Date Received
    June 17, 2005
    Report Date
    June 17, 2005
    Manufacturer
    COOK MEDICAL INCORPORATED
    Product Code
    DQO
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NY, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    CHILD HAD HICKMAN CATHETER PLACED WHICH WAS NOTED TO HAVE A HOLE IN IT. CATHETER REMOVED AND NEW ONE INSERTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 COOK TPN DOUBLE LUMEN CATHETER SET DQO COOK MEDICAL INCORPORATED 7.0 FRENCH F1723047

    Patients

    Seq Age Sex Outcome Treatment
    1 4 YR Other