BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BARD GROSHONG PORT

    MDR report key: 1972789 · Received January 21, 2011

    Report

    Report Number
    MW5019151
    Event Type
    Malfunction
    Date Received
    January 21, 2011
    Date of Event
    January 17, 2011
    Report Date
    January 21, 2011
    Manufacturer
    BARD, INC.
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    GROSHONG PORT MALFUNCTION WHICH CAUSED NEED TO REMOVE PORT AND INSERT NEW ONE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD GROSHONG PORT BARD GROSHONG PORT LJT BARD, INC. 0602850

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR