BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BARDPORT: IMPLANTED PORT 0710443 REV2 0602R

    MDR report key: 2113323 · Received May 27, 2011

    Report

    Report Number
    MW5020828
    Event Type
    Injury
    Date Received
    May 27, 2011
    Date of Event
    May 19, 2011
    Report Date
    May 27, 2011
    Manufacturer
    C.R. BARD, INC.
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    REMOVAL OF MEDIPORT. CHEMOTHERAPY COMPLETED AND MEDIPORT WAS PAINFUL. WHEN THE PORT WAS REMOVED, THE CATHETER WAS NOT PRESENT. UPON X-RAY, IT WAS IN THE PT'S HEART.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARDPORT: IMPLANTED PORT 0710443 REV2 0602R CATHETER LJT C.R. BARD, INC. 0602830 REUA0320

    Patients

    Seq Age Sex Outcome Treatment
    1 21 YR Hospitalization