BEUDAMED
    FDA Adverse Event Death Summary report: N

    VENA TECH-LGM

    MDR report key: 124222 · Received October 1, 1997

    Report

    Report Number
    124222
    Event Type
    Death
    Date Received
    October 1, 1997
    Date of Event
    September 26, 1997
    Report Date
    September 30, 1997
    Manufacturer
    VENA TECH B. BRAUN MEDICAL
    Product Code
    DTK
    Report Source
    User Facility report
    Reporter Location
    OH, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    A VENA CAVA FILTER WAS IMPLANTED IN THE PT. IT FAILED TO DEPLOY AND MIGRATED TO THE HEART. IT BECAME LODGED IN THE PULMONARY ARTERY. THE PT SUBSEQUENTLY DIED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 VENA TECH-LGM Implant VENA CAVA FILTER DTK VENA TECH B. BRAUN MEDICAL 31327 *

    Patients

    Seq Age Sex Outcome Treatment
    1 38 YR Death