BEUDAMED
    FDA Adverse Event Death Summary report: N

    CVP CATHETER 3 LUMEN EXPANDED KIT

    MDR report key: 10254 · Received September 30, 1993

    Report

    Report Number
    10254
    Event Type
    Death
    Date Received
    September 30, 1993
    Date of Event
    September 23, 1993
    Report Date
    September 27, 1993
    Manufacturer
    ABBOTT LABORATORIES
    Product Code
    DQO
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    CA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PT ADMITTED 9/12/93 FOR SBO. TO OR 9/12/93 AT 1:00, FOR EXPLORATORY LAP WITH RELEASE OF SBO. PT TAKEN BACK TO SURGERY 9/21/93 AT 1450 FOR SBO WITH PERSISTENT OBSTRUCTION. OPERATION PERFORMED: EXPLORATORY LAPAROTOMY, LYSIS OF ADHESIONS, RESECTION OF TERMINAL ILEUM AND PROXIMOL RIGHT COLON WITH ILEOSTOMY (PT HAD INSERTION OF INTERNAL JUGULAR TRIPLE LUMEN LINE AT THIS TIME ALSO). ON 9/23/93, THE PT CODED AND EXPIRED. AUTOPSY REVEALED CAUSE OF DEATH AS PERICARDIAL TAMPONADE DUE TO PERFORATION OF RIGHT ATRIUM DUE TO CENTRAL VENOUS LINE PLACEMENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CVP CATHETER 3 LUMEN EXPANDED KIT CENTRAL VENOUS CATHETER 20 CM 7 FR DQO ABBOTT LABORATORIES 41401-04-01 UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 37 YR Death