BEUDAMED
    FDA Adverse Event Death Summary report: N

    BARD

    MDR report key: 2081799 · Received May 3, 2011

    Report

    Report Number
    MW5020493
    Event Type
    Death
    Date Received
    May 3, 2011
    Date of Event
    July 23, 2009
    Report Date
    May 3, 2011
    Manufacturer
    BARD MEDICAL DIV.
    Product Code
    DTK
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NC, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    IVC FILTER STRUT FRACTURE WITH MIGRATION OF STRUT TO A PERIPHERAL PULMONARY ARTERY POSITION. BARD G2 EXPRESS FILTER IMPLANTED ON (B)(6) 2009 AND PT UNDERWENT GASTRIC OUTLET PROCEDURE FOR MORBID OBESITY LATER THAT DAY. STRUT IN PULMONARY ARTERY POSITION NOTED RETROSPECTIVELY ON CHEST IMAGE OF (B)(6) 2009. ATTEMPT AT REMOVAL OF FILTER TO BE UNDERTAKEN.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD BARD G2 EXPRESS VENA CAVA FILTER DTK BARD MEDICAL DIV. GFTC2587

    Patients

    Seq Age Sex Outcome Treatment
    1 33 YR Congenital Anomaly| D| H| L| O| R| S