BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BARD

    MDR report key: 201932 · Received December 14, 1998

    Report

    Report Number
    201932
    Event Type
    Malfunction
    Date Received
    December 14, 1998
    Date of Event
    October 14, 1998
    Report Date
    December 11, 1998
    Manufacturer
    BARD ACCESS SYSTEMS
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    MI, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    INSERT PORT ON 10/13/1998. HAD TO BE REMOVED THE NEXT DAY 10/14/1998 AS PORT WOULD NOT ASPIRATE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD Implant HICKMAN DOUBLE LUMEN LJT BARD ACCESS SYSTEMS 602170 36816116

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR Other