BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MEDCOMP DUAL LUMEN VASCU PICC

    MDR report key: 8189862 · Received December 20, 2018

    Report

    Report Number
    MW5082411
    Event Type
    Malfunction
    Date Received
    December 20, 2018
    Date of Event
    December 12, 2018
    Report Date
    December 19, 2018
    Manufacturer
    MEDICAL COMPONENTS INC. (DBA MEDCOMP)
    Product Code
    LJS
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    FL, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PATIENT HAD PICC LINE PLACED IN RIGHT ARM, AND PICC CATHETER FRACTURED WHILE INSIDE PATIENT'S ARM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1027453 MEDCOMP DUAL LUMEN VASCU PICC CATHETER, INTRAVASCULAR, THERAPEUTIC LONG-TERM GREATER THAN 30 DAYS LJS MEDICAL COMPONENTS INC. (DBA MEDCOMP) MLNH110

    Patients

    Seq Age Sex Outcome Treatment
    1 8 MO Other