BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    IMPLANTED PORT WITH GROSHONG CATHETER

    MDR report key: 1061159 · Received June 2, 2008

    Report

    Report Number
    1061159
    Event Type
    Malfunction
    Date Received
    June 2, 2008
    Date of Event
    April 11, 2008
    Report Date
    June 2, 2008
    Manufacturer
    BARD ACCESS SYSTEMS
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    FL, US

    Narratives

    Description of Event or Problem · 1

    PORT IMPLANTED RECENTLY. IT WAS REMOVED NINE DAYS LATER. CATHETER FRACTURED AT JUNCTION/CONNECTION WITH DEVICE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 IMPLANTED PORT WITH GROSHONG CATHETER PORT,VASCULAR ACCESS LJT BARD ACCESS SYSTEMS * RERK0667

    Patients

    Seq Age Sex Outcome Treatment
    1 43 YR