BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PROPORT

    MDR report key: 1032724 · Received April 14, 2008

    Report

    Report Number
    1032724
    Event Type
    Malfunction
    Date Received
    April 14, 2008
    Date of Event
    April 10, 2008
    Report Date
    April 14, 2008
    Manufacturer
    SMITHS MEDICAL MD, INC.
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    UT, US

    Narratives

    Description of Event or Problem · 1

    PATIENT WAS DIAGNOSED WITH BREAST CANCER APPROXIMATELY ONE YEAR AGO. A CATHETER WAS PLACED EARLIER THIS YEAR. SINCE THEN THE CATHETER FRACTURED OR SEPARATED. THE CATHETER WAS REPLACED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PROPORT PORT, VASCULAR ACCESS LJT SMITHS MEDICAL MD, INC. 21-4165-24 M48788

    Patients

    Seq Age Sex Outcome Treatment
    1 27 YR