MAUDE Adverse Event Report: ARROW INTERNATIONAL LLC ARROW PI PICC 1-LUMEN: 4FR X 55CM W/ 130CM NIT; CATHETER INTRAVASCULAR THERAPE

Catalog Number	PR-35541-HPHNL
Medical Device Problem Code	Material Twisted/Bent (2981)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	06/09/2025
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(4).
Event or Problem Description
It was reported "piccs kinking close to hub and affecting medication delivery.Five piccs in total.Separate patients for each with the date range spread over the week prior to 9/6." the picc line was removed as the patient was near end of treatment.The patient's current condition is reported as "fine".Associated mdr numbers include: 9680794-2025-00561, 9680794-2025-00560, 9680794-2025-00559, 9680794-2025-00557.
Additional Manufacturer Narrative
(b)(4).Corrected data: section d.4.-catalog# corrected to pr-35541-hphnl complaint verification testing could not be performed as no sample was returned for analysis.A device history record review was performed and no relevant findings were identified.Without the device to evaluate the complaint could not be confirmed and the probable cause could not be determined from the available information.Teleflex will continue to monitor and trend for reports of this nature.If the sample becomes available at a later date a follow up report will be submitted with investigation results.
Event or Problem Description
It was reported "piccs kinking close to hub and affecting medication delivery.Five piccs in total.Separate patients for each with the date range spread over the week prior to (b)(6)." the picc line was removed as the patient was near end of treatment.The patient's current condition is reported as "fine".Associated mdr numbers include: 9680794-2025-00561, 9680794-2025-00560, 9680794-2025-00559, 9680794-2025-00557, and 9680794-2025-00558.

• Brand Name: ARROW PI PICC 1-LUMEN: 4FR X 55CM W/ 130CM NIT
• Common Device Name: CATHETER INTRAVASCULAR THERAPE
• Manufacturer (Section D): ARROW INTERNATIONAL LLC; morrisville NC
• Manufacturer (Section G): ARROW INTERNATIONAL DE MEXICO S.A. DE C.V.; ave. washington 3701; colonia panamericana, chihuahua; chihuahua 31200 ; MX 31200
• Manufacturer Contact: katharine tarpley ; 3015 carrington mill blvd; morrisville, NC 27560
• MDR Report Key: 22413711
• Report Number: 9680794-2025-00558
• Device Sequence Number: 9692453
• Product Code: LJS
• UDI-Device Identifier: 00801902095565
• UDI-Public: (01)00801902095565(11)241106(17)260331(10)33F24K0699(21)
• Combination Product (Y/N): N
• Initial Reporter Country: NZ
• PMA/510(K) Number: K113277
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,User Facility
• Initial Reporter Occupation: Nurse
• Type of Report: Initial,Followup
• Report Date (Section B): 06/11/2025

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Expiration Date: 03/31/2026
• Device Catalogue Number: PR-35541-HPHNL
• Device Lot Number: 33F24K0699
• Was Device Available for Evaluation?: Yes
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 06/11/2025
• Supplement Date Received by Manufacturer: 07/30/2025
• Initial Report FDA Received Date: 07/07/2025
• Supplement Report FDA Received Date: 08/04/2025
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 11/06/2024
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: NOT REPORTED; NOT REPORTED
• Patient Sex: Unknown