| Brand Name | ARROW PI PICC 2L 5FRX40CM W/80CM HYDRO NIT SWG |
| Common Device Name | CATHETER, INTRAVASCULAR, THER |
| 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 | 24830716 |
| Report Number | 9680794-2026-00278 |
| Device Sequence Number | 10447042 |
| Product Code |
LJS
|
| UDI-Device Identifier | 10801902197112 |
| UDI-Public | (01)10801902197112(11)250711(17)270228(10)33F25F0305(21) |
| Combination Product (Y/N) | N |
| Initial Reporter Country | TW |
| PMA/510(K) Number | K113277 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,User Facility |
| Initial Reporter Occupation |
Other
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
03/20/2026 |
| 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 Catalogue Number | PR-34052-HPHNM |
| Device Lot Number | 33F25F0305 |
| Was Device Available for Evaluation? |
Yes
|
| Is the Reporter a Health Professional? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 03/20/2026 |
| Supplement Date Received by Manufacturer | 05/06/2026
|
| Initial Report FDA Received Date | 04/09/2026 |
| Supplement Report FDA Received Date | 05/12/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
Device Not Returned to Manufacturer
|
| Date Device Manufactured | 07/11/2025 |
| 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 |
| Patient Sex | Unknown |
|
|