BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PORT-A CATH SINGLE LUMEN 8.5 FR

    MDR report key: 237953 · Received August 5, 1999

    Report

    Report Number
    237953
    Event Type
    Injury
    Date Received
    August 5, 1999
    Date of Event
    August 2, 1999
    Report Date
    August 3, 1999
    Manufacturer
    SIMS DELTEC INC
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    IA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    VAP INSERTED ON 7-29-99. RECEIVED NAVELBINE 50 MGM ON 07-29-99. FLUSH ON 08-02-99 SHOWED PUFFINESS. PART REMOVED & UNABLE TO RETRIEVE CATHETER WHICH WAS DISCONNECTED FROM PORT. SENT TO VASCULAR SURGEON FOR RETRIEVAL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PORT-A CATH SINGLE LUMEN 8.5 FR Implant VENOUS ACCESS SYSTEM LJT SIMS DELTEC INC * 67188

    Patients

    Seq Age Sex Outcome Treatment
    1 72 YR Required Intervention