BEUDAMED
    FDA Adverse Event Other Summary report: N

    -

    MDR report key: 780939 · Received November 13, 2006

    Report

    Report Number
    MW1040937
    Event Type
    Other
    Date Received
    November 13, 2006
    Report Date
    October 20, 2006
    Manufacturer
    BARD ACCESS SYSTEMS, INC.
    Product Code
    LJS
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    FL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    A GUIDEWIRE FRAGMENT, BROKE OFF FROM PICC POST INSERTION. IT IS NOW LOCATED IN THE RIGHT PULMONARY ARTERY SYSTEM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 - POWER PICC LJS BARD ACCESS SYSTEMS, INC. * REQF0757

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Other