BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BARD

    MDR report key: 1802836 · Received August 10, 2010

    Report

    Report Number
    MW5017070
    Event Type
    Malfunction
    Date Received
    August 10, 2010
    Date of Event
    July 26, 2010
    Report Date
    August 10, 2010
    Manufacturer
    BARD ACCESS FIELD ASSURANCE
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    GA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    BARD POWER PORT REMOVED FROM LEFT CHEST/SUBCLAVIAN VEIN. CATHETER CRACKED ON SIDE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD POWER PORT LJT BARD ACCESS FIELD ASSURANCE RESH0790

    Patients

    Seq Age Sex Outcome Treatment
    1 54 YR