BEUDAMED
    FDA Adverse Event Injury Summary report: N

    G2 JUGULAR SUBCLAVIAN FILTER

    MDR report key: 1356520 · Received April 3, 2009

    Report

    Report Number
    MW5010632
    Event Type
    Injury
    Date Received
    April 3, 2009
    Date of Event
    March 25, 2009
    Report Date
    April 3, 2009
    Manufacturer
    BARD PERIPHERAL VASCUALR
    Product Code
    DTK
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    TN, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    DR. WAS INSERTING A 1J VENA CAVA FILTER IN THIS PATIENT. WHEN HE DEPLOYED, SEVERAL HOOKS STUCK TOGETHER. WE HAD TO OPEN SEVERAL MORE ITEMS TO REMOVE THE FILTER INCLUDING BAR "CONE" AND AMPLATZ WIRES AND SECOND IVC FILTER. ADDITIONAL 1-1 1/2 HOURS ADDED TO CASE. FILTER WAS KEPT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 G2 JUGULAR SUBCLAVIAN FILTER IVC FILTER DTK BARD PERIPHERAL VASCUALR RF-320J GFSL2745

    Patients

    Seq Age Sex Outcome Treatment
    1 90 YR Disability