BEUDAMED
    FDA Adverse Event Injury Summary report: N

    VORTEX PORT

    MDR report key: 171877 · Received June 5, 1998

    Report

    Report Number
    1450392-1998-00008
    Event Type
    Injury
    Date Received
    June 5, 1998
    Date of Event
    April 17, 1998
    Report Date
    May 27, 1998
    Manufacturer
    NORFOLK MEDICAL PRODUCTS, INC.
    Product Code
    LJT
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    ID, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    ACCORING TO THE OFFICE NURSE THE DR WAS REMOVING THE PORT AND THE "CATHETER SHEARED----THE PT WAS TRANSFERRED TO THE HOSPITAL WHERE THE DISTAL PORTION OF THE CATHETER WAS REMOVED".

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 VORTEX PORT Implant DRUG DELIVERY DEPOT LJT NORFOLK MEDICAL PRODUCTS, INC. P5955 971101

    Patients

    Seq Age Sex Outcome Treatment
    1 * Required Intervention