BEUDAMED
    FDA Adverse Event Injury Summary report: N

    COOK GUNTHER TULIP

    MDR report key: 2030958 · Received March 23, 2011

    Report

    Report Number
    MW5019942
    Event Type
    Injury
    Date Received
    March 23, 2011
    Date of Event
    January 25, 2010
    Report Date
    March 14, 2011
    Manufacturer
    COOK
    Product Code
    DTK
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    TN, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    I WENT TO THE ER ROOM. WAS TOLD THAT THEY WERE GOING TO DO ALTERNATE CATHETERIZATION TO SEE IF I HAD ANY BLOCKED ARTERY BLOCKAGE. DIAGNOSIS OR REASON FOR USE: BLOOD CLOTS IN LEGS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 COOK GUNTHER TULIP VENA CAVA FILTER DTK COOK

    Patients

    Seq Age Sex Outcome Treatment
    1 59 YR Hospitalization| L| O| S MEDS TAKEN AT TIME