BEUDAMED
    FDA Adverse Event Injury Summary report: N

    IMPLANTED POWERPICC

    MDR report key: 2113562 · Received June 1, 2011

    Report

    Report Number
    3006260740-2011-00160
    Event Type
    Injury
    Date Received
    June 1, 2011
    Report Date
    May 11, 2011
    Manufacturer
    C. R. BARD, INC. (BASD)
    Product Code
    LJS
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    NURSE

    Narratives

    Additional Manufacturer Narrative · 1

    THE DEVICE HAS NOT BEEN RETURNED TO THE MFR AT THIS TIME FOR EVAL. A LHR REVIEW IS NOT POSSIBLE, AS NO MFG LOT NUMBER HAS BEEN PROVIDED BY THE COMPLAINANT.

    Description of Event or Problem · 1

    FACILITY HAD A COMPLICATION WHICH REQUIRED INTERVENTIONAL RADIOLOGY TO REMOVE THE GUIDEWIRE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 IMPLANTED POWERPICC PERCUTANEOUS, IMPLANTED LONG TERM INTRAVASCULAR CATHETER LJS C. R. BARD, INC. (BASD) UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 90 YR Required Intervention