BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LIFEPORT

    MDR report key: 20736 · Received March 27, 1995

    Report

    Report Number
    MW1005562
    Event Type
    Injury
    Date Received
    March 27, 1995
    Date of Event
    October 24, 1994
    Report Date
    March 5, 1995
    Manufacturer
    STRATO MEDICAL CORP.
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    PATIENT

    Narratives

    Description of Event or Problem · 1

    ROUTINE CHEST X-RAY DURING COURSE OF CHEMOTHERAPY INDICATED FRAGMENT OF PORT-A-CATH WAS DISCONNECTED AND LODGED IN THE RIGHT ATRIUM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LIFEPORT Implant PORT-A-CATH LJT STRATO MEDICAL CORP. 402605

    Patients

    Seq Age Sex Outcome Treatment
    1 37 YR Required Intervention