MalfunctionDQO
POWER PICC
Received Mar 22, 2005 · Event occurred Feb 28, 2005
Report 590911 · MDR key 590911
Device
Generic name
Picc Iv Line
Manufacturer
Bard Access SsytemsModel number
5 FRENCH DLCatalog number
*
Lot number
*
Product problems
- Coagulation in Device or Device Ingredient
Patient
41 YR
- Unknown (for use when the patient's condition is not known)
Narrative
Description of Event or Problem
A RIGHT UPPER ARM PICC LUMEN CLOTTED. CAPPED RED PORT WITH CLC 2000 CAP.