BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BARD PORT IMPLANTED PORT

    MDR report key: 1921128 · Received December 1, 2010

    Report

    Report Number
    MW5018532
    Event Type
    Injury
    Date Received
    December 1, 2010
    Report Date
    November 30, 2010
    Manufacturer
    CR BARD, INC
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    KY, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PT IN FOR REMOVAL OF PORT-A-CATH. PORT AND PORTION OF CATHETER REMOVED. X-RAYS REVEALS PART OF CATHETER RETAINED IN PT'S R ATRIUM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD PORT IMPLANTED PORT PORTACATH LJT CR BARD, INC RESA0628

    Patients

    Seq Age Sex Outcome Treatment
    1 56 YR Hospitalization