BEUDAMED
    FDA Adverse Event Other Summary report: N

    BD FIRST PICC PERIPHERALLY INSERTED CENTRAL CATHETER

    MDR report key: 872911 · Received June 27, 2007

    Report

    Report Number
    1710034-2007-00061
    Event Type
    Other
    Date Received
    June 27, 2007
    Date of Event
    June 8, 2007
    Report Date
    June 18, 2007
    Manufacturer
    BECTON DICKINSON INFUSION THERAPY SYSTEMS, INC.
    Product Code
    LJS
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    UNKNOWN

    Narratives

    Additional Manufacturer Narrative · 1

    ONE USED UNIT WAS REC'D ON 25 JUNE 2007 AND SENT FOR DECONTAMINATION. UPON DECONTAMINATION OF THE SAMPLE AND COMPLETION OF THE INVESTIGATION, A SUPPLEMENTAL REPORT WILL BE SUBMITTED.

    Description of Event or Problem · 1

    THE CATHETER WAS INSERTED IN 2007. APPROXIMATELY, 3 MONTHS LATER, THE PT HUNG THE TUBE OF THE INFUSION SET STEPPING AND THE CATHETER CUT. THE LINE HAD TO BE SECURED AGAIN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BD FIRST PICC PERIPHERALLY INSERTED CENTRAL CATHETER PERCUTANEOUS CATHETER LJS BECTON DICKINSON INFUSION THERAPY SYSTEMS, INC. NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 17 YR Other