BEUDAMED
    FDA Adverse Event Death Summary report: N

    CRESCENT JUGULAR DUAL LUMEN

    MDR report key: 10521334 · Received September 7, 2020

    Report

    Report Number
    10521334
    Event Type
    Death
    Date Received
    September 7, 2020
    Date of Event
    August 21, 2020
    Report Date
    September 4, 2020
    Manufacturer
    MC3 CARDIOPULMONARY
    Product Code
    PZS
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    NY, US
    Reporter Occupation
    501

    Narratives

    Description of Event or Problem · 1

    BREAK IN CRESCENT ECMO CATHETER INSERTED AT ANOTHER HOSPITAL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    964660 CRESCENT JUGULAR DUAL LUMEN ECMO CANNULA PZS MC3 CARDIOPULMONARY 70128

    Patients

    Seq Age Sex Outcome Treatment
    1 40 YR Death