BEUDAMED
    FDA Adverse Event Other Summary report: N

    VARTEC

    MDR report key: 1464331 · Received August 24, 2009

    Report

    Report Number
    MW5012591
    Event Type
    Other
    Date Received
    August 24, 2009
    Date of Event
    March 1, 2009
    Report Date
    August 21, 2009
    Manufacturer
    KENYON WALLS & ASSOCIATES
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NC, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    PT HAD PORT-A-CATH PLACED IN 2009. AFTER 1 OR 2 USES, THE CATHETER BROKE OFF IN PT'S VEIN AND FLOATED THROUGH HER PULMONARY ARTERY HEART INTO HER LUNGS. IT IS STILL THERE. THE BROKEN PORT-A-CATH WAS REMOVED APPROX FIVE MONTHS LATER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 VARTEC PORT-A-CATH LJT KENYON WALLS & ASSOCIATES * 964591

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR Other