BEUDAMED
    FDA Adverse Event Death Summary report: N

    TESIO LOCK RIGHT ADAPTOR

    MDR report key: 168290 · Received May 18, 1998

    Report

    Report Number
    168290
    Event Type
    Death
    Date Received
    May 18, 1998
    Date of Event
    February 11, 1998
    Report Date
    May 8, 1998
    Manufacturer
    MED COMP
    Product Code
    LFJ
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    FL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PT FOUND AT HOME WITH MASSIVE BLEEDING FROM LEFT SUBCLAVIAN CATHETER DOUBLE PORT FOR DIALYSIS. ONE OF THE PORTS WAS BROKEN (BLUE). PT ARRIVED IN ER, INTUBATED, AND IN ASYSTOLE. PT EXPIRED 02/11/98 0238.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TESIO LOCK RIGHT ADAPTOR TESIO EXTENSION LFJ MED COMP UNK UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 55 YR Death