BEUDAMED
    FDA Adverse Event Death Summary report: N

    BARD RECOVERY FILTER

    MDR report key: 1589582 · Received January 25, 2010

    Report

    Report Number
    MW5014526
    Event Type
    Death
    Date Received
    January 25, 2010
    Date of Event
    January 11, 2010
    Report Date
    January 25, 2010
    Manufacturer
    BARD PERIPHERAL VASCULAR
    Product Code
    DTK
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    FLUOROSCOPY IN 2008 FOUND IVC FILTER SEGMENT IN THE RIGHT VENTRICLE. THIS WAS RE-EVALUATED IN (B) (6). 2009. THE TINE BROKEN FROM THE IVC FILTER REMAINED IN THE RIGHT VENTRICLE. IN (B) (6) 2010, THE PATIENT DIED AT HOME. NO AUTOPSY WAS PERFORMED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD RECOVERY FILTER IVC FILTER DTK BARD PERIPHERAL VASCULAR RF-048F

    Patients

    Seq Age Sex Outcome Treatment
    1 64 YR Death